Complementary feeding approach and maternal responsiveness in 8- and 12-month-old Italian infants: A longitudinal study.

In Western countries, infants are usually introduced to solids through spoon-fed puréed foods (parent-led weaning, PLW). However, an alternative approach known as "baby-led weaning" (BLW), in which infants usually participate in family meals and eat independently, is becoming increasingly popular. We investigated the relationship between the type of complementary feeding approach and maternal responsiveness to infant feeding cues in a longitudinal sample of 178 infants observed at 8 and 12 months. Mothers reported the complementary feeding method used and, from video-recorded meals, we coded the proportion of time infants self-fed and rated maternal responsiveness by means of the Responsiveness to Child Feeding Cues Scale (Hodges et al., 2013). Responsiveness to infant receptiveness and fullness cues were significantly correlated at 8 months, but not at 12 months, when unresponsiveness decreased for receptiveness but remained stable for fullness cues. Thus, as infants got older, mothers were increasingly tuned in to their receptiveness cues. However, we did not observe the same pattern for fullness cues, perhaps because mothers were concerned that their infants did not eat enough. Moreover, at both time points, mothers were more responsive to infants' receptiveness than fullness cues, possibly due to an evolutionary drive to protect infants from starvation. Finally, responsiveness to fullness, but not responsiveness to receptiveness, was positively related to the proportion of infant self-feeding, but there were no significant differences in responsiveness depending on the self-reported complementary feeding approach. Thus, a weaning style that emphasizes independent feeding, regardless of whether this is labeled as BLW, may promote more infant-centered maternal responses at the end of the meal, with potential implications for promoting infant self-regulation not only at mealtimes, but also in other domains.

Neurodevelopmental outcome in one-year-old children born preterm: differences between low birth weight and very low birth weight.

BACKGROUND: In preterm infants, low birth weight represents one of the major risk factors for health and developmental issues. In Italy, most of the studies are focused on extremely preterm or Very and Extremely Low Birth Weight (VLBW, ELBW) children, whereas little data are available on the neurodevelopmental outcome of Low Birth Weight (LBW) children. We aimed to study the developmental profile of a group of preterm children at 12 months of corrected age, comparing cognitive, language and motor performances between LBW and VLBW. METHODS: We assessed 108 children born preterm (53 LBW and 55 VLBW) at 12 months of corrected age (M= 12.9 months; SD = .95) with Bayley-III. We compared the mean scores between and within groups and the rates of mild and severe delay using the Italian norms. RESULTS: LBW children performed better than VLBW peers, particularly in the cognitive and gross motor areas. No differences between groups were found in relation to language subscales. The rate of mild and severe delay is elevated in both groups, resulting significantly higher in the VLBW group only in the motor area. CONCLUSIONS: These results strongly suggest the need of a multidisciplinary follow-up to monitor the development of premature newborns, including those with birth weights above 1500 g. The early identification of cognitive, language and motor problems is essential to promote children's well-being and intervention prior to school entry.

Online Assessment of Motor, Cognitive, and Communicative Achievements in 4-Month-Old Infants.

Remote methods for data collection allow us to quickly collect large amounts of data, offering several advantages as compared to in-lab administration. We investigated the applicability of an online assessment of motor, cognitive, and communicative development in 4-month-old infants based on several items of the Bayley Scales of Infant Development, 3rd edition (BSID-III). We chose a subset of items which were representative of the typical developmental achievements at 4 months of age and that we could administer online with the help of the infant's caregiver using materials which were easily available at home. Results showed that, in a sample of infants tested live (N = 18), the raw scores of the BSID-III were significantly correlated with the raw scores of a subset of items corresponding to those administered to a sample of infants tested online (N = 53). Moreover, for the "online" participants, the raw scores of the online assessment did not significantly differ from the corresponding scores of the "live" participants. These findings suggest that the online assessment was to some extent comparable to the live administration of the same items, thus representing a viable opportunity to remotely evaluate infant development when in-person assessment is not possible.

Infant sleep and development: Concurrent and longitudinal relations during the first 8 months of life.

Sleep is an essential function of human life, underlying both biological and cultural processes. Dramatic changes in sleep occur during infancy, in terms of night awakenings, which tend to diminish over time, and day/night sleep duration, with newborns sleeping up to 16-17 h per day and gradually decreasing to 9-13 h between 6 and 11 months of age. Remarkably, research indicates that changes in infant sleep are in interaction with important acquisitions in other domains of child development. In the present study, we aimed at investigating concurrent and longitudinal relations between sleep and cognitive maturation during infancy, by collecting data on 156 infants at 4 and 8 months of age. Infants' sleep was assessed through the Brief Infant Sleep Questionnaire (BISQ; Sadeh, 2004), whereas cognitive maturation was evaluated using the Developmental Profile™ 3 (Alpern 2007). We also examined infants' language understanding through the short form of the Italian version of the MacArthur-Bates Communicative Development Inventory (MCDI-SF): Words and Gestures (Caselli, Bello, Rinaldi, Stefanini, & Pasqualetti, 2015; Fenson et al., 2000). Finally, information about infants' temperament and maternal practices potentially relevant for sleep quality, such as the use of a pacifier at nighttime, co-sleeping and exclusive breastfeeding, was detected. Results showed that night and day sleep were differently related to infants' development at 4 and 8 months of age, but there were no robust longitudinal relationships.

Neonatal Hyperglycemia Related to Parenteral Nutrition Affects Long-Term Neurodevelopment in Preterm Newborn: A Prospective Cohort Study.

(1) Background: Recent evidence reported a reduced tolerance of macronutrient parenteral intakes in subjects in critically ill conditions. We designed a prospective cohort study to evaluate the effects of hyperglycemia (HG) related to parenteral nutrition (PN) on neurodevelopment (NDV) in survived preterm newborns. (2) Methods: Enrolled newborns with gestational age < 32 weeks or birth weight < 1500 g, were divided in two cohorts: (A) exposed to moderate or severe HG (glucose blood level > 180 mg/dL) in the first week of life; (B) not exposed to HG. We considered as the primary outcome the rate of preterm newborns survived without NDV delay at 24 months of life, evaluated with Bayley Scales of Infants Development III edition. (3) Results: We analyzed 108 (A 32 vs. B 76) at 24 months of life. Newborns in cohort A showed a higher rate of cognitive and motor delay (A 44% vs. B 22 %, p = 0.024; A 38% vs. B 8%, p < 0.001). When adjusting for background characteristics, HG remained a risk factor for motor delay. (4) Conclusions: High nutritional intakes through PN soon after birth increase the risk of HG. The consequences of this severe metabolic complication affect long-term NDV and survival in preterm newborns.

Energy-enhanced parenteral nutrition and neurodevelopment of preterm newborns: A cohort study.

OBJECTIVES: Preterm births are at higher risk for neurodevelopment (NDV) disabilities. To limit long-term consequences, guidelines recommend aggressive parenteral nutrition (PN) soon after birth. The aim of this study was to examine the effects of energy-enhanced PN in the first week of life on long-term NDV in preterm neonates. METHODS: We compared two cohorts of newborns (group A: energy-enhanced PN and group B: energy-standard PN) with different energy intake in the first 7 d of life (DoL) given by PN with the same protein amount, to study the influences of an energy-enhanced PN on NDV at 24 mo of life evaluated with the Bayley Scale of Infant Development-III edition. RESULTS: We analyzed 51 newborns (A: n = 24 versus B: n = 27). The two cohorts were similar in baseline characteristics (gestational age group A 29 wk, 95% confidence interval [CI], 28-30 wk versus group B 29 wk, 95% CI, 28-30 wk; birth weight A: 1214 g, 95% CI, 1062-1365 g versus B 1215 g, 95% CI, 1068-1363 g; boys A 62.5% versus B 55.6%). Infants in cohort B showed significantly (P < 0.05) better gross motor, total scaled, and total composite motor scores (A: 8 (1) versus B 9 (2); A 17 (4) versus B 19 (5); A 91 (12) versus B 97 (15); respectively). Cohort A showed a higher percentage of infants with delayed socioemotional competence (A 30.4% versus B 7.7%, P < 0.05). No differences were found in growth parameters at 24 mo of life. Linear regression analysis showed that socioemotional competence and motor score were negatively associated with energy intake of the first 7 DoL given by PN. CONCLUSIONS: A more aggressive PN strategy results in lower motor score and socioemotional competence performance at 24 mo of life. More caution might be advocated for an energy-enhanced PN protocol, particularly in neonates with lower birth weight, for long-term NDV in preterm neonates.

Early Protein Intake Influences Neonatal Brain Measurements in Preterms: An Observational Study.

Introduction: To limit extrauterine growth restriction, recent guidelines on nutrition of preterm neonates recommended high protein intake since the first day of life (DOL). The impact of this nutritional strategy on the brain is still controversial. We aimed to evaluate the effects of protein intake on early cerebral growth in very low birth weight newborns. Materials and Methods: We performed serial cranial ultrasound (cUS) scans at 3-7 DOL and at 28 DOL in very low birth weight newborns consecutively observed in the neonatal intensive care unit. We analyzed the relation between protein intake and cerebral measurements at 28 DOL performed by cUS. Results: We enrolled 100 newborns (gestational age 29 ± 2 weeks, birth weight 1,274 ± 363 g). A significant (p < 0.05) positive correlation between enteral protein intake and biparietal diameter (r = 0.490**), occipital-frontal diameter (r = 0.608**), corpus callosum (length r = 0.293*, genu r = 0.301*), caudate head (right r = 0.528**, left r = 0.364**), and cerebellum (transverse diameter r = 0.440**, vermis height r = 0.356**, vermis width r = 0.377**) was observed at 28 DOL. Conversely, we found a significant negative correlation of protein intake given by parenteral nutrition (PN) with biparietal diameter (r = -0.524**), occipital-frontal diameter (r = -0.568**), body of corpus callosum (r = -0.276*), caudate head (right r = -0.613**, left r = -0.444**), and cerebellum (transverse diameter r = -0.403**, vermis height r = -0.274*, vermis width r = -0.462**) at 28 DOL. Multivariate regression analysis showed that measurements of occipital-frontal diameter, caudate head, and cerebellar vermis at 28 DOL depend positively on protein enteral intake (r = 0.402*, r = 0.305*, and r = 0.271*) and negatively by protein parenteral intake (r = -0.278*, r = -0.488*, and r = -0.342*). Conclusion: Brain development in neonatal life depends on early protein intake. High protein intake affects cerebral structures' measurements of preterm newborn when administered by PN. Positive impact on brain development encourages the administration of recommended protein intake mainly by enteral nutrition.

Neurodevelopmental outcome of Italian preterm children at 1year of corrected age by Bayley-III scales: An assessment using local norms.

BACKGROUND: Premature birth is often associated with neurodevelopmental difficulties throughout childhood. In the first three years of life, the Bayley Scales of Infant and Toddler Development-Third Edition (Bayley-III) constitute one of the most used tools for assessing child development. Since Bayley-III original norms are based on United States (US) population, it remains uncertain whether their use in other countries (e.g., European) is appropriate. AIMS: This research aimed to examine neurodevelopment of preterm infants and full-term infants, using Bayley-III US norms in comparison to Italian (IT) norms. Patterns of developmental outcomes for both infant groups were also explored. METHODS: 104 preterm and 58 full-term infants were included in the study. Bayley-III was used for neurodevelopmental assessment at 1year of corrected age, considering both IT and US norms for scores computation. RESULTS: Comparing scores obtained with IT vs US norms, differences in means were all significant across five subscales (p<0.05 at least) for preterm infants, whereas for full-term peers significant differences were found only for Receptive Language and Fine Motor subscales (p<0.001). Effect size (η2) ranged from 0.22 to 0.94. Within each group, significant discrepancies across subscales were found. Moreover, Italian preterm infants had significantly lower performances than full-term peers, excepting for Expressive Language and Gross Motor subscales. CONCLUSIONS: As regards to Italian 1-year children, our study seems to provide evidence for the tendency of Bayley-III US norms to overestimate development compared to IT norms. These findings emphasize the need to early detect children at risk for developmental delay and to plan early intervention.

One-year neurodevelopmental outcome of very and late preterm infants: Risk factors and correlation with maternal stress.

Although "late preterm" (LP) newborns (33-36 weeks of gestational age) represent more than 70% of all preterm labors, little is known about the relation between certain risk factors and developmental outcomes in LP compared to "very preterm" (≤32 weeks) children (VP). This study investigates: (1) LP and VP infants' development at 12 months of corrected age (CA) using the Bayley Scales of Infant Development - 3rd Edition (BSID-III); (2) correlation between BSID-III performances and maternal stress (using Parenting Stress Index-Short Form, PSI-SF) among LP and VP at 12 months CA; and (3) the link between known neonatal and demographic risk factors and developmental outcomes of LP and VP infants. For both LP and VP infants the Mean Cognitive (LP: 102.69±7.68; VP: 103.63±10.68), Language (LP: 96.23±10.08; VP: 99.10±10.37) and Motor (LP: 91.11±10.33; VP: 93.85±10.17) composite scores were in the normal range, without significant differences between the groups. Correlations between PSI-SF and BSID-III showed that in the VP group (but not LP), Language score was negatively related to the PSI-SF 'Difficult Child' scale (r=-.34, p<.05). Regression models revealed that cognitive performance was significantly predicted by physical therapy in LP and by cesarean section in VP infants. For VP only maternal education and length of stay predicted Language score, whereas physical therapy predicted Motor score. Results of the study underline the importance of considering cognitive, language and motor developments separately when assessing a preterm child's development. Prediction models of developmental performance confirm the influence of some known neonatal risk factors and indicate the need for further research on the role of sociodemographic risk factors.

Cross-cultural adaptation, reliability and predictive validity of the Italian version of Developmental Coordination Disorder Questionnaire (DCDQ).

BACKGROUND: Developmental coordination disorder (DCD) is a motor disorder of unclear etiology that severely interferes with a child's ability to perform daily motor tasks. As a useful alternative to a time-consuming motor test and specialist evaluation, parents or teachers can complete motor questionnaires. A tool used worldwide to screen motor performance in 4- to 14-year-old children is the Developmental Coordination Disorder Questionnaire 2007 (DCDQ'07). AIMS: To describe how we translated the Developmental Coordination Disorder Questionnaire 2007 (DCDQ'07) and adapted it to the Italian population and to test its preliminary psychometric properties in Italian children. METHODS: Parents of a clinical group of 26 children (5-11 years old) with a diagnosis of DCD and 52 matched controls completed the DCDQ translated into Italian and adapted for cross-cultural purposes according to current guidelines. Twenty-four parents of typically developing children randomly selected completed the questionnaire twice to examine test-retest reliability. RESULTS: The internal consistency value (Cronbach alpha) for the Italian DCDQ was 0.94. The Italian DCDQ achieved moderate-to-high test-retest reliability (ICC) for 14/15 items and a good diagnostic performance for identifying children with DCD (sensitivity 88% and specificity 96%). CONCLUSIONS: The Italian DCDQ is a valid screening tool for assessing motor performance in 5- to 11-year-old children that merits research in a larger sample.