Neurodevelopmental status and follow-up in preschool children with heart disease in London, UK.

OBJECTIVE: To describe neurodevelopment and follow-up services in preschool children with heart disease (HD). DESIGN: Secondary analysis of a prospectively collected multicentre dataset. SETTING: Three London tertiary cardiac centres. PATIENTS: Preschool children<5 years of age: both inpatients and outpatients. METHODS: We analysed results of Mullen Scales of Early Learning (MSEL) and parental report of follow-up services in a representative convenience sample evaluated between January 2014 and July 2015 within a previous study. RESULTS: Of 971 preschool children: 577 (59.4%) had ≥1 heart operation, 236 (24.3%) had a known diagnosis linked to developmental delay (DD) ('known group') and 130 (13.4%) had history of clinical event linked to DD. On MSEL assessment, 643 (66.2%) had normal development, 181 (18.6%) had borderline scores and 147 (15.1%) had scores indicative of DD. Of 971 children, 609 (62.7%) were not receiving follow-up linked to child development and were more likely to be under these services with a known group diagnosis, history of clinical event linked to DD and DD (defined by MSEL). Of 236 in known group, parents of 77 (32.6%) and of 48 children not in a known group but with DD 29 (60.4%), reported no child development related follow-up. DD defined by MSEL assessment was more likely with a known group and older age at assessment. CONCLUSIONS: Our findings indicate that a 'structured neurodevelopmental follow-up pathway' in preschool children with HD should be considered for development and evaluation as children get older, with particular focus on those at higher risk.

Early Hypoxic Respiratory Failure in Extreme Prematurity: Mortality and Neurodevelopmental Outcomes.

OBJECTIVES: To evaluate the survival and neurodevelopmental impairment (NDI) in extremely low birth weight (ELBW) infants at 18 to 26 months with early hypoxemic respiratory failure (HRF). We also assessed whether African American infants with early HRF had improved outcomes after exposure to inhaled nitric oxide (iNO). METHODS: ELBW infants ≤1000 g and gestational age ≤26 weeks with maximal oxygen ≥60% on either day 1 or day 3 were labeled as "early HRF" and born between 2007 and 2015 in the Neonatal Research Network were included. Using a propensity score regression model, we analyzed outcomes and effects of exposure to iNO overall and separately by race. RESULTS: Among 7639 ELBW infants born ≤26 weeks, 22.7% had early HRF. Early HRF was associated with a mortality of 51.3%. The incidence of moderate-severe NDI among survivors was 41.2% at 18 to 26 months. Mortality among infants treated with iNO was 59.4%. Female sex (adjusted odds ratio [aOR]: 2.4, 95% confidence interval [CI]: 1.8-3.3), birth weight ≥720 g (aOR: 2.3, 95% CI: 1.7-3.1) and complete course of antenatal steroids (aOR: 1.6, 95% CI: 1.1-2.2) were associated with intact survival. African American infants had a similar incidence of early HRF (21.7% vs 23.3%) but lower exposure to iNO (16.4% vs 21.6%). Among infants with HRF exposed to iNO, intact survival (no death or NDI) was not significantly different between African American and other races (aOR: 1.5, 95% CI: 0.6-3.6). CONCLUSIONS: Early HRF in infants ≤26 weeks' gestation is associated with high mortality and NDI at 18 to 26 months. Use of iNO did not decrease mortality or NDI. Outcomes following iNO exposure were not different in African American infants.

Racial/Ethnic Disparities Among Extremely Preterm Infants in the United States From 2002 to 2016.

Importance: Racial/ethnic disparities in quality of care among extremely preterm infants are associated with adverse outcomes. Objective: To assess whether racial/ethnic disparities in major outcomes and key care practices were changing over time among extremely preterm infants. Design, Setting, and Participants: This observational cohort study used prospectively collected data from 25 US academic medical centers. Participants included 20 092 infants of 22 to 27 weeks' gestation with a birth weight of 401 to 1500 g born at centers participating in the National Institute of Child Health and Human Development Neonatal Research Network from 2002 to 2016. Of these infants, 9316 born from 2006 to 2014 were eligible for follow-up at 18 to 26 months' postmenstrual age (excluding 5871 infants born before 2006, 2594 infants born after 2014, and 2311 ineligible infants including 64 with birth weight >1000 g and 2247 infants with gestational age >26 6/7 weeks), of whom 745 (8.0%) did not have known follow-up outcomes at 18 to 26 months. Main Outcomes and Measures: Rates of mortality, major morbidities, and care practice use over time were evaluated using models adjusted for baseline characteristics, center, and birth year. Data analyses were conducted from 2018 to 2019. Results: In total, 20 092 infants with a mean (SD) gestational age of 25.1 (1.5) weeks met the inclusion criteria and were available for the primary outcome: 8331 (41.5%) black infants, 3701 (18.4%) Hispanic infants, and 8060 (40.1%) white infants. Hospital mortality decreased over time in all groups. The rate of improvement in hospital mortality over time did not differ among black and Hispanic infants compared with white infants (black infants went from 35% to 24%, Hispanic infants went from 32% to 27%, and white infants went from 30% to 22%; P = .59 for race × year interaction). The rates of late-onset sepsis among black infants (went from 37% to 24%) and Hispanic infants (went from 45% to 23%) were initially higher than for white infants (went from 36% to 25%) but decreased more rapidly and converged during the most recent years (P = .02 for race × year interaction). Changes in rates of other major morbidities did not differ by race/ethnicity. Death before follow-up decreased over time (from 2006 to 2014: black infants, 14%; Hispanic infants, 39%, white infants, 15%), but moderate-severe neurodevelopmental impairment increased over time in all racial/ethnic groups (increase from 2006 to 2014: black infants, 70%; Hispanic infants, 123%; white infants, 130%). Rates of antenatal corticosteroid exposure (black infants went from 72% to 90%, Hispanic infants went from 73% to 83%, and white infants went from 86% to 90%; P = .01 for race × year interaction) and of cesarean delivery (black infants went from 45% to 59%, Hispanic infants went from 49% to 59%, and white infants went from 62% to 63%; P = .03 for race × year interaction) were initially lower among black and Hispanic infants compared with white infants, but these differences decreased over time. Conclusions and Relevance: Among extremely preterm infants, improvements in adjusted rates of mortality and most major morbidities did not differ by race/ethnicity, but rates of neurodevelopmental impairment increased in all groups. There were narrowing racial/ethnic disparities in important care practices, including the use of antenatal corticosteroids and cesarean delivery.

Association between maternal and child mental health among US Latinos: variation by nativity, ethnic subgroup, and time in the USA.

Few studies have examined the association between maternal and youth mental health among US Latinos, or its variation by nativity, country of origin, ethnic subgroup, and time in the mainland US. Using 2007-2014 Medical Expenditure Panel Survey data linking Latino youth (N = 15,686 aged 5-17 years) and their mothers, we estimated multivariate models of the relationship between probable maternal mental illness (a composite of measures) and youth mental health impairment (Columbia Impairment Scale). Children of mothers with probable mental illness were more than three times as likely to have impairment as children of mothers without mental illness (p < 0.01). In adjusted models, there was an 8.5-point (95% CI 5.1, 11.8) increased prevalence of child impairment associated with mother's probable mental illness among mainland US-born youth and mothers and a 6.0-point (95% CI 3.7, 8.3) increased prevalence among US-born youth of foreign/island-born mothers. There was no significant difference in the prevalence of youth impairment associated with maternal mental illness when both youth and mother were born outside of the mainland US. For the Puerto Rican subgroup, the association between maternal and youth mental health was greatest among island-born mothers and mainland US-born youth; for the Mexican subgroup, the link was strongest among US-born mothers and youth. While there were large point differences between those groups, the difference was not statistically significant. This study suggests a protective effect of island/foreign-born nativity on symptom association between Latino mothers and children. Considerations for future research and practice stemming from this finding are discussed.

Psychiatric symptoms in traumatized Syrian refugee children settled in Hatay.

Aim: After the beginning of the Syrian civil war in 2011, its cruelty and violence forced about millions to leave their homes. These experiences might create serious mental problems, especially in children and adolescents who might have an increased risk of developing post-traumatic stress disorder (PTSD) and depression. In this study, we aimed to investigate the mental health status of Syrian refugee children who exposed to a variety of traumatic events.Method: The sample consisted of 1518 drug-naive Syrian refugee children and adolescents aged between 8 and 16 years who were admitted to the Child and Adolescent Psychiatry Department in Hatay State Hospital between June 2016 and December 2018. The CRIES-13 (Children's Revised Impact of Event Scale-13) was used to evaluate PTSD symptoms and CDI (Children's Depression Inventory) was used to examine depressive symptoms. The sample was divided into three groups according to the type of trauma and the CRIES-13 and CDI scores were compared between the groups.Results: The mean age of the children was 12.4 ± 3.1. 46.9% of the children were male and 53.1% were female. The total score and intrusion and arousal subscores of CRIES-13 were significantly different between the three groups. The total CDI score was also significantly different between the three groups. The likelihood rates of PTSD and depression differed significantly between the groups.Conclusion: Traumatized Syrian refugee children may present PTSD symptoms more likely than depressive symptoms. War-related traumatic experiences may have more adverse effects on Syrian children's psychology than other traumas.

Factors Influencing Low Prevalence of Neurodevelopmental Disabilities Among US Hispanic/Latino Children.

OBJECTIVES: Hispanic/Latino (H/L) children have lower prevalence of neurodevelopmental disabilities (NDD) than other groups. The explanations for this are complex, but may be related to nativity, language barriers, and lack of access to and utilization of healthcare. Previous research focused on how these factors affect children with NDD, but little research has jointly examined whether these factors predict NDD. This study examines whether social and environmental factors explain low prevalence of NDD in this population. METHODS: This study uses nationally representative Integrated Public Use Microdata Series National Health Interview Survey data (N = 200,622) and multivariate logistic regression analysis to compare NDD prevalence in white and H/L children (average age of 10.2), and examines whether nativity, healthcare access, healthcare utilization, and language barriers explain this disability disparity. RESULTS: Findings reveal that the H/L NDD disparity is not explained by differences in access to or utilization of healthcare, or as a result of language differences that may create barriers to NDD diagnosis. While H/L children whose sampled adult was born in the USA have lower rates of NDD than whites, H/Ls whose sampled adult were not born in the USA have even lower probability of NDD than H/Ls who were born in the USA. CONCLUSIONS: These findings may be a result of cultural differences in knowledge or understanding of what constitutes a disability or the result of differential treatment within the healthcare system among H/Ls. The findings underscore the importance of accessible and culturally appropriate health and clinical care interventions among H/L communities.

Assessing social recovery of vulnerable youth in global mental health settings: a pilot study of clinical research tools in Malaysia.

BACKGROUND: A social recovery approach to youth mental health focuses on increasing the time spent in valuable and meaningful structured activities, with a view to preventing enduring mental health problems and social disability. In Malaysia, access to mental health care is particularly limited and little research has focused on identifying young people at risk of serious socially disabling mental health problems such as psychosis. We provide preliminary evidence for the feasibility and acceptability of core social recovery assessment tools in a Malaysian context, comparing the experiential process of engaging young Malaysian participants in social recovery assessments with prior accounts from a UK sample. METHODS: Nine vulnerable young people from low-income backgrounds were recruited from a non-government social enterprise and partner organisations in Peninsular Malaysia. Participants completed a battery of social recovery assessment tools (including time use, unusual experiences, self-schematic beliefs and values). Time for completion and completion rates were used as indices of feasibility. Acceptability was examined using qualitative interviews in which participants were asked to reflect on the experience of completing the assessment tools. Following a deductive approach, the themes were examined for fit with previous UK qualitative accounts of social recovery assessments. RESULTS: Feasibility was indicated by relatively efficient completion time and high completion rates. Qualitative interviews highlighted the perceived benefits of social recovery assessments, such as providing psychoeducation, aiding in self-reflection and stimulating goal setting, in line with findings from UK youth samples. CONCLUSIONS: We provide preliminary evidence for the feasibility and acceptability of social recovery assessment tools in a low-resource context, comparing the experiential process of engaging young Malaysian participants in social recovery assessments with prior accounts from a UK sample. We also suggest that respondents may derive some personal and psychoeducational benefits from participating in assessments (e.g. of their time use and mental health) within a social recovery framework.

Mental Health Prevention in Preschool Children: study protocol for a feasibility and acceptability randomised controlled trial of a culturally adapted version of the I Can Problem Solve (ICPS) Programme in Chile.

BACKGROUND: Difficulties with delaying gratification, coping with frustration, and regulating emotions are significant predictors of aggression and behavioural and interpersonal problems early in life and mental health disorders during childhood, adolescence, and adulthood. Mental health problems generate a high burden of disease in society in general, and there is a significant treatment gap, especially among economically vulnerable populations. Prevention strategies appear to be the more recommendable options, mainly if these interventions can be implemented early in life and at low cost. Few preventive interventions aiming to increase resilience in the face of adversity have been rigorously evaluated among Chilean preschoolers. Substantial international evidence indicates that strengthening basic psychological skills, such as emotion regulation and social problem-solving, can reduce the incidence of mental pathology and improve various academic indicators. The curriculum of the Interpersonal Cognitive Problem-Solving Programme, also known as I Can Problem Solve (ICPS), is focussed on the development of the cognitive process and children's social problem-solving skills. ICPS is effective at increasing prosocial behaviours and reducing aggressive behaviour among preschoolers. ICPS provides children with the skills to think about how to solve problems using sequenced games, discussion, and group-interaction techniques focussed on listening to, and observing, others, promoting empathy and alternative and consequential thinking. The aims of this study are (1) to develop a culturally appropriate version of the ICPS programme and (2) to evaluate the acceptability and feasibility of the adapted version of ICPS among vulnerable schools in Santiago, Chile, conducting a pilot randomised controlled trial with three arms: (1) the ICPS programme delivered by an internal early teacher, (2) the ICPS programme delivered by an external early teacher, and (3) a control group. METHODS AND DESIGN: This is a pilot, three-armed randomised controlled trial of the adapted version of ICPS with an enrolment target of 80 preschoolers attending four schools per arm. Children in both intervention groups will receive the ICPS programme: 59 sessions of 20 min each delivered three times a week by trained internal or external early teachers over 5-6 months. Internal teachers are part of the school staff, and external teachers are facilitators hired by the research team to go to schools and deliver the intervention during a normal school day, working together with the early teacher present in the classroom. The intervention consists of games using pictures, puppets, and simple role-playing techniques to facilitate the learning process. Cognitive regulation, emotion recognition, social-problem-solving skills, and psychological functioning will be measured at baseline and after the intervention. DISCUSSION: No previous studies in Spanish-speaking Latin American countries have been conducted to explore the acceptability and feasibility of ICPS to provide information to evaluate the effectiveness of this intervention on a larger scale. TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT03383172 . Registered on 26 December 2017.

Early prenatal vitamin D concentrations and social-emotional development in infants.

BACKGROUND: Many pregnant women in the United States have suboptimal vitamin D, but the impact on infant development is unclear. Moreover, no pregnancy-specific vitamin D recommendations have been widely accepted. AIMS: Given the ubiquitous expression of vitamin D receptors in the brain, we investigated the association between early prenatal plasma 25-hydroxyvitamin D (25(OH)D) concentrations and children's social and emotional development in the Newborn Epigenetic Study, a prospective study of pregnancies from 2009 to 2011 in Durham, North Carolina. METHODS: We measured 25(OH)D concentrations in first or second trimester plasma samples and categorized 25(OH)D concentrations into quartiles. Covariates were derived from maternal questionnaires. Mothers completed the Infant Toddler Social-Emotional Development Assessment when children were 12-24 months of age. We used multivariable linear regression to evaluate associations between 25(OH)D and specific behavior scores, adjusted for season of blood draw, maternal age, education, parity, smoking, marital status, prepregnancy BMI, and infant gender. We investigated effect-measure modification by race/ethnicity. RESULTS: Of the 218 mother-infant pairs with complete data, Black mothers had much lower 25(OH)D concentrations as compared to White and Hispanic mothers. After adjustment, lower prenatal 25(OH)D was associated with slightly higher (less favorable) Internalizing scores among White children, but lower (more favorable) Internalizing scores among Black and Hispanic children. Lower prenatal 25(OH)D also appears to be associated with higher (less favorable) dysregulation scores, though only among White and Hispanic children. CONCLUSIONS: Though imprecise, preliminary results warrant further investigation regarding a role for prenatal vitamin D on children's early social and emotional development.

Clinical Application of Chromosome Microarray Analysis in Han Chinese Children with Neurodevelopmental Disorders.

Chromosome microarray analysis (CMA) is a cost-effective molecular cytogenetic technique that has been used as a first-line diagnostic test in neurodevelopmental disorders in the USA since 2011. The impact of CMA results on clinical practice in China is not yet well studied, so we aimed to better evaluate this phenomenon. We analyzed the CMA results from 434 patients in our clinic, and characterized their molecular diagnoses, clinical features, and follow-up clinical actions based on these results. The overall diagnostic yield for our patients was 13.6% (59 out of 434). This gave a detection rate of 14.7% for developmental delay/intellectual disability (DD/ID, 38/259) and 12% for autism spectrum disorders (ASDs, 21/175). Thirty-three recurrent (n ≥ 2) variants were found, distributed at six chromosomal loci involving known chromosome syndromes (such as DiGeorge, Williams Beuren, and Angelman/Prader-Willi syndromes). The spectrum of positive copy number variants in our study was comparable to that reported in Caucasian populations, but with specific characteristics. Parental origin tests indicated an effect involving a significant maternal transmission bias to sons. The majority of patients with positive results (94.9%) had benefits, allowing earlier diagnosis (36/59), prioritized full clinical management (28/59), medication changes (7/59), a changed prognosis (30/59), and prenatal genetic counseling (15/59). Our results provide information on de novo mutations in Chinese children with DD/ID and/or ASDs. Our data showed that microarray testing provides immediate clinical utility for patients. It is expected that the personalized medical care of children with developmental disabilities will lead to improved outcomes in long-term developmental potential. We advocate using the diagnostic yield of clinically actionable results to evaluate CMA as it provides information of both clinical validity and clinical utility.

Language Assessment for Children With a Range of Neurodevelopmental Disorders Across Four Languages in South Africa.

Purpose: The purpose of this study is (a) to examine the applicability of a culturally and linguistically adapted measure to assess the receptive and expressive language skills of children with neurodevelopmental disorders (NDDs) in South Africa and then (b) to explore the contributions of 2 additional language measures. Method: In Part 1, 100 children with NDD who spoke Afrikaans, isiZulu, Setswana, or South African English were assessed on the culturally and linguistically adapted Mullen Scales of Early Learning (MSEL). Clinicians independently rated the children's language skills on a 3-point scale. In Part 2, the final 20 children to be recruited participated in a caregiver-led interaction, after which the caregiver completed a rating scale about their perceptions of their children's language. Results: Performance on the MSEL was consistent with clinician-rated child language skills. The 2 additional measures confirmed and enriched the description of the child's performance on the MSEL. Conclusions: The translated MSEL and the supplemental measures successfully characterize the language profiles and related skills in children with NDD in multilingual South Africa. Together, these assessment tools can serve a valuable function in guiding the choice of intervention and also may serve as a way to monitor progress.

Understanding the structure and processes of primary health care for young indigenous children.

INTRODUCTION Primary health care organisations need to continuously reform to more effectively address current health challenges, particularly for vulnerable populations. There is growing evidence that optimal health service structures are essential for producing positive outcomes. AIM To determine if there is an association between process of care indicators (PoCIs) for important young indigenous child health and social issues and: (i) primary health-care service and child characteristics; and (ii) organisational health service structures. METHODS This was a cross-sectional study of 1554 clinical child health audits and associated system assessments from 74 primary care services from 2012 to 2014. Composite PoCIs were developed for social and emotional wellbeing, child neurodevelopment and anaemia. Crude and adjusted logistic regression models were fitted, clustering for health services. Odds ratios and 95% confidence intervals were derived. RESULTS Overall, 32.0% (449) of records had a social and emotional wellbeing PoCI, 56.6% (791) had an anaemia PoCI and 49.3% (430) had a child neurodevelopment PoCI. Children aged 12-23 months were significantly more likely to receive all PoCIs compared to children aged 24-59 months. For every one point increase in assessment scores for team structure and function (aOR 1.14, 95% CI 1.01-1.27) and care planning (aOR 1.14, 95% CI 1.01-1.29) items, there was a 14% greater odds of a child having an anaemia PoCI. Social and emotional wellbeing and child neurodevelopment PoCIs were not associated with system assessment scores. DISCUSSION Ensuring young indigenous children aged 24-59 months are receiving quality care for important social and health indicators is a priority. Processes of care and organisational systems in primary care services are important for the optimal management of anaemia in indigenous children.

Differences in early cognitive and receptive-expressive neurodevelopment by ancestry and underlying pathways in Brazil and Argentina.

We examine disparities in early child cognitive and receptive-expressive skills by ethnic ancestry among infants aged 3-24 months from Brazil and Argentina. We employ unique data on the neurodevelopment of children who were seeking routine well-child care at a set of pediatric clinics in these countries. The sample included children who had normal birth outcomes and no major health complications, allowing us to focus on variation in neurodevelopment among children without major physical health limitations. The physicians attending the pediatric clinics were trained in administering the Bayley Infant Neurodevelopmental Screener, a standardized instrument used to screen an infant's risk of neurodevelopmental problems on various domains of abilities. We evaluate disparities in overall neurodevelopmental scores and risk for neurodevelopmental problems as well as in cognitive functioning and receptive-expressive neurodevelopment. We also examine the extent to which household demographic and socioeconomic characteristics and geographic location explain these disparities. We find large gaps in both cognitive and receptive-expressive neurodevelopment by ancestry. In Brazil, children of African ancestry have lower scores on both cognitive and receptive-expressive domains and on overall neurodevelopment than children of European ancestry. In Argentina, children of Native ancestry have lower scores on these outcomes than children of European ancestry. These gaps however are largely explained by differences in geographic location and household characteristics, highlighting the importance of policies that reduce socioeconomic and geographic disparities in social capital and economic development for eliminating ethnic disparities in infant neurodevelopment.