Beyond TORCH: A narrative review of the impact of antenatal and perinatal infections on the risk of disability.

Infections and inflammation during pregnancy or early life can alter child neurodevelopment and increase the risk for structural brain abnormalities and mental health disorders. There is strong evidence that TORCH infections (i.e., Treponema pallidum, Toxoplasma gondii, rubella virus, cytomegalovirus, herpes virus) alter fetal neurodevelopment across multiple developmental domains and contribute to motor and cognitive disabilities. However, the impact of a broader range of viral and bacterial infections on fetal development and disability is less well understood. We performed a literature review of human studies to identify gaps in the link between maternal infections, inflammation, and several neurodevelopmental domains. We found strong and moderate evidence respectively for a higher risk of motor and cognitive delays and disabilities in offspring exposed to a range of non-TORCH pathogens during fetal life. In contrast, there is little evidence for an increased risk of language and sensory disabilities. While guidelines for TORCH infection prevention during pregnancy are common, further consideration for prevention of non-TORCH infections during pregnancy for fetal neuroprotection may be warranted.

Assessing 5-Year Outcomes of an Academic Pediatrics-Community Partnership Focused on Rural Child Health.

BACKGROUND: The Resident Education in Advocacy and Child Health (REACH) pathway at a large academic pediatric residency program in the Northwest includes an academic-community partnership in a rural community. Few academic-community partnership evaluations have focused on community values. REACH trainees conducted a 5-year evaluation of the partnership using community-generated outcomes measures. We sought to 1) apply community-based participatory research (CBPR) principles to engage community stakeholders, 2) mutually develop program evaluation measures, and 3) describe core projects and the community's perceptions of the REACH program. A secondary objective was to evaluate REACH pathway influence on trainee alumni. METHODS: We used a community-informed design to determine outcomes and indicators, 2) gathered data through iterative review of materials, stakeholder interviews, and alumni surveys, and 3) conducted a quantitative and qualitative analysis and synthesis. RESULTS: Four short-term outcomes measures were identified for a logic model: 1) project sustainability, 2) direct engagement with youth, 3) Community partnerships, and 4) "ripple effects." Of non-foundational projects, 50% were sustained at the time of the evaluation. Fourteen projects (70%) engaged youth. At least five ongoing community partnerships were identified. Four stakeholders (24%) noted a ripple effect. Trainee alumni reported increased confidence in research skills, cultural competence, and appreciation of community perspectives. Key themes of the partnership's value were relationships, outsider perspective and professional expertise, trainees as catalyst, and balance of research with action. CONCLUSIONS: Our evaluation demonstrated the partnership's value to community and trainees and yielded suggestions for increasing the program's impact. We believe that key elements of this evaluation could be used in other academic-community partnership programs.

Neurocognitive function among HIV-infected children on protease inhibitor -based versus non-protease inhibitor based antiretroviral therapy in Uganda: a pilot study.

BACKGROUND: HIV infection is associated with significant neurocognitive deficits making maximization of cognitive function among children receiving antiretroviral therapy (ART) a public health imperative. Non-protease inhibitors (non-PIs) achieve higher drug levels in the cerebral spinal fluid (CSF) compared to PIs, potentially leading to better neurocognitive function by reducing CSF viral load and inflammation. ART that maximises children's neurodevelopment and school achievement could result in improved quality of life and productivity as adults, but little research to date has examined whether non-PI ART is associated with better neurocognitive outcomes. We compared the neurocognitive function between children living with HIV receiving PI-based and non PI-based ART. METHODS: We recruited a consecutive sample of clinically stable Ugandan children living with HIV aged 5-12 years who received PI-based or non PI-based ART for ≥ 1 year (viral load < 1000 copies). Neurocognitive function was assessed using the Kaufman Assessment Battery for Children, the Test of Variables of Attention, and Bruininks-Oseretsky Test of Motor Proficiency. Age-adjusted neurocognitive z-scores for the two groups were compared using linear regression models in STATA version 13. The Hommel's method was used to adjust for multiple testing. RESULTS: We enrolled 76 children living with HIV; 34 on PI ART and 42 on non-PI ART. Mean (±SD) age was greater in the non-PI vs. PI group (9.5 ± 1.9 vs. 8.5 ± 2.0) years (p = 0.03). Children in the non-PI group had lower socioeconomic scores (5.7 ± 3.3 vs. 7.4 ± 2.8, p = 0.02). There was no difference in neurocognitive function between the groups (adjusted p > 0.05) for KABC and TOVA. Children in the PI group had better total BOT scores than their counterparts (46.07 ± 1.40) vs. 40.51 (1.24), p = 0.03). CONCLUSIONS: We detected no difference in neurocognitive function among children on PI and non PI-based ART therapy based on KABC and TOVA tests. Children on PI based ART had better motor function than their counterparts. We recommend a prospective study with a larger sample size.