Search Results (53)

Objective: To comprehensively evaluate the interaction between diet quality and multivitamin intake during pregnancy on offspring neurodevelopment. Methods: This analysis was grounded in mother-child dyads from the 3D Cohort Study in Quebec, Canada. Among the 2366 participants initially enrolled in the 3D study, 1535 women successfully completed the 3-day food record during 20–24 weeks of gestation. A Canadian adaptation of the Healthy Eating Index (HEI-C) 2010 was used to quantify diet quality. The total HEI-C score was dichotomized into low and high diet quality by median split. Cognitive and motor development in childhood were assessed using the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III). Language abilities were measured using the toddler short-form version of the MacArthur–Bates Communicative Development Inventories (MCDI) questionnaire, administered in either English or French. After excluding participants with missing covariate data, cognitive, motor, and language development scores at 2 years of age were available for 1066, 1040, and 981 children, respectively. Multiple linear regression models were employed to calculate adjusted effect estimates. The interaction on an additive scale was assessed by incorporating a product term into the linear regression model. Results: Statistically significant interactions were detected between diet quality and multivitamin intake in relation to the cognitive and language development outcomes of the offspring (interaction p-values were 0.018 and 0.023, respectively). The lowest cognitive and language scores were observed in the group of women who neither took multivitamins nor maintained a high-quality diet. Among women not taking multivitamins, a high-quality diet was associated with improved offspring cognitive and language scores (mean difference [95% CI] = 4.2 [0.1, 8.2], p = 0.04; and 11.3 [3.1, 19.5], p = 0.01, respectively). However, among women taking multivitamins, no such associations were identified. Conversely, in participants with a low-quality diet, multivitamin intake was associated with a 3.0-point increase in cognitive composite scores (95% CI: 0.3, 5.8, p = 0.03), but this was not the case for those with a high-quality diet. No statistically significant interactions were observed between maternal diet quality and multivitamin intake for motor development outcomes. Conclusions: Adequate nutritional supply during pregnancy, achieved either through a high-quality diet or multivitamin supplementation, is fundamental for the neurodevelopment of children. Full article

Background/Objectives: Preterm infants are at high risk of extrauterine growth restriction and suboptimal neurological development due to cumulative nutrient deficits. Standard fortification (SF) of human milk does not account for individual macronutrient variability, potentially leading to inadequate intake. Target fortification (TFO) adjusts supplementation based on the measured macronutrient content, aimed at providing macronutrient intake aligned with ESPGHAN (European Society for Paediatric Gastroenterology, Hepatology and Nutrition) recommendations and optimize growth and development. This study aims to evaluate the effects of TFO compared to SF on growth, body composition, and neurological outcomes at 18 months corrected age. Methods: In this double-blind, randomized controlled trial, preterm infants (<30 weeks gestation) received either SF or TFO for at least three weeks. Macronutrient levels in breast milk were analyzed three times per week, with modular adjustments in the TFO group. Growth parameters, body composition at 36 weeks postmenstrual age, and Bayley Scales of Infant and Toddler Development III (BSID-III) scores at 18 months corrected age were assessed (n = 69). Results: TFO significantly increased protein, fat, and carbohydrate intake compared to SF, leading to higher weight gain (2514 ± 289 g vs. 2283 ± 332 g, p < 0.01) and growth velocity (21.7 ± 2.3 g/kg/d vs. 19.2 ± 2.2 g/kg/d, p < 0.001). In infants whose mother’s milk had low protein levels, fat-free mass was significantly higher with TFO compared to SF. BSID-III scores were higher in the TFO group across cognitive, language, and motor domains, with significant improvements in expressive language scores in infants whose mother’s milk had high protein levels (p < 0.05). The number of preterm infants with a motor BSID-III score of ≤70 was significantly lower in the TFO group compared to the SF group (0 vs. 3, p < 0.05). Conclusions: TFO enhanced growth and body composition and may support better neurological outcomes in preterm infants. While most BSID-III differences were not statistically significant, the data suggest that TFO may reduce the risk of developmental delays. Larger, multicenter trials are needed to confirm these findings. Full article

Background: The percentage of preterm infants requiring surgery before 44 weeks of postmenstrual age (PMA) varies between 19% and 36%. The potential impact of general anesthesia on the vulnerable developing brain of preterm infants remains unknown. Methods: A systematic review and meta-analysis on the impact of general anesthesia on brain integrity and neurodevelopmental outcomes in preterm infants undergoing surgery before 44 weeks PMA was conducted. Studies were identified via a PubMed, EMBASE (Ovid), and Cochrane CENTRAL search conducted from inception until 8 March 2023, following PRISMA guidelines. Brain abnormality was assessed using MRI-based brain volume and abnormality scores. Neurodevelopment was evaluated through Bayley Infant and Toddler Development (BSID) or Wechsler Preschool and Primary Scale of Intelligence (WPPSI) tests. Quality was assessed via the Cochrane ROBINS-I tool and GRADE. Results: Our systematic search identified 2883 records, leading to the inclusion of 12 observational studies. Very low-quality evidence suggests that preterm infants exposed to anesthesia were more likely to show postoperative brain abnormalities on MRI (OR 2.01, 95%CI 1.24–3.25, p = 0.005). They had lower neurodevelopmental scores on the BSID II and III (psychomotor developmental index: mean difference (MD) −10.98; 95%CI −12.04 to −9.91; p < 0.001 and cognitive composite score: (MD) −10.11; 95%CI −11.06 to −9.16; p < 0.001 at two years of age compared to preterm infants not exposed to anesthesia. Conclusion: Exposure to surgery and anesthesia before term age is associated with brain abnormalities and neurodevelopmental delay at two years, but conclusions are limited by low evidence quality, uncontrolled confounders, and the methodological biases of the included studies; thus further robust studies are required (PROSPERO:CRD42021255907). Full article

Background/Objectives: There is a constant need to improve the prediction of adverse neurodevelopmental outcomes in growth-restricted neonates who were born prematurely. The aim of this retrospective study was to evaluate the predictive performance of a three-layered neural network for the prediction of adverse neurodevelopmental outcomes determined at two years of age by the Bayley Scales of Infant and Toddler Development, 3rd edition (Bayley-III) scale in prematurely born infants by affected by intrauterine growth restriction (IUGR). Methods: This observational retrospective study included premature newborns with or without IUGR admitted to a tertiary neonatal intensive care unit from Romania, between January 2018 and December 2022. The patients underwent assessment with the Amiel-Tison scale at discharge, and with the Bailey-3 scale at 3, 6, 12, 18, and 24 months of corrected age. Clinical and paraclinical data were used to construct a three-layered artificial neural network, and its predictive performance was assessed. Results: Our results indicated that this type of neural network exhibited moderate predictive performance in predicting mild forms of cognitive, motor, and language delays. However, the accuracy of predicting moderate and severe neurodevelopmental outcomes varied between moderate and low. Conclusions: Artificial neural networks can be useful tools for the prediction of several neurodevelopmental outcomes, and their predictive performance can be improved by including a large number of clinical and paraclinical parameters. Full article

Background: The balance of omega-6/omega-3 (n-6/n-3) is crucial for proper brain function as they have opposite physiological roles. Objectives: To analyze the association between maternal serum ratios of n-6/n-3 in the first and third trimesters of pregnancy and the neurodevelopment of their children in the early days after birth in the population of Northern Spain’s Mediterranean region. Methods: Longitudinal study in which 336 mother–child pairs participated. Mother serum concentrations of long-chain polyunsaturated fatty acids (LCPUFAs), docosahexaenoic acid (DHA), eicosapentaenoic acid (EPA), and arachidonic acid (ARA) were determined. Sociodemographic, clinical, lifestyle habits, and obstetrical variables were collected. The Bayley Scales of Infant and Toddler Development (BSID-III) was used to assess infant neurodevelopment. Multiple linear regression models adjusting for confounding factors were performed. Results: In the third trimester, a higher maternal n-6/n-3 ratio was negatively associated with infant motor development (β = −0.124, p = 0.023). Similarly, higher ARA/DHA ratios were negatively associated with total motor (β = −2.005, p = 0.002) and fine motor development (β = −0.389, p = 0.001). No significant associations were observed in the first trimester nor for the ARA/EPA ratio in the third trimester. Conclusions: Our findings indicate that an elevated n-6/n-3 ratio and ARA/DHA ratio in the third trimester of pregnancy are associated with poorer motor development outcomes in infants. These results highlight the importance of optimizing maternal fatty acid balance during pregnancy to support fetal neurodevelopment, suggesting a need for further research to verify these associations and elucidate underlying mechanisms. Full article

Background/Objectives: The first year of life represents a critical developmental stage in which the foundations for motor, cognitive, language, and social–emotional development are set. During this time, development occurs rapidly, making early detection of developmental disorders essential for timely intervention. The Bayley Scales of Infant and Toddler Development—Third Edition (Bayley-III) is an effective tool for assessing language, motor, and cognitive development in children aged 1 to 42 months. This study aimed to investigate whether or not the results of the Bayley-III in healthy one-year-old children are predictive for their later motor skills and school performance. Methods: This study had a prospective, longitudinal design. The study participants were healthy children having performed Bayley-III at 1 year with information on motor performance (n = 170) at age 5–10 and school grades (n = 69) at age 7–10. Linear or logistic regression analysis was performed for data analysis. Results: Below-average performance in the cognitive part of the Bayley-III at age 1 was significantly associated with poorer performance in balancing backwards (b = −0.45), sideways jumping (b = −0.42), standing long jump (b = −0.54), and forward bends (b = −0.59) at age 5–10 (all p < 0.05). Performance in other parts of the Bayley-III was not significantly associated with later motor skills. Furthermore, we did not observe any significant associations between performance in the Bayley-III and grades in school. The associations were not moderated by age, sex, or socioeconomic status (all p > 0.05). Conclusions: The cognitive scale of the Bayley-III may be used as a predictive tool for later motor skills. Regarding school performance, the Bayley-III cannot be considered predictive. Full article

Brain networks are hypothesized to undergo significant changes over development, particularly during infancy. Thus, the aim of this study is to evaluate brain maturation in the first year of life in terms of electrophysiological (EEG) functional connectivity (FC). Whole-brain FC metrics (i.e., magnitude-squared coherence, phase lag index, and parameters derived from graph theory) were extracted, for multiple frequency bands, from baseline EEG data recorded from 146 typically developing infants at 6 (T6) and 12 (T12) months of age. Generalized linear mixed models were used to test for significant differences in the computed metrics considering time point and sex as fixed effects. Correlational analyses were performed to ascertain the potential relationship between FC and subjects’ cognitive and language level, assessed with the Bayley-III scale at 24 (T24) months of age. The results obtained highlighted an increased FC, for all the analyzed frequency bands, at T12 with respect to T6. Correlational analyses yielded evidence of the relationship between FC metrics at T12 and cognition. Despite some limitations, our study represents one of the first attempts to evaluate brain network evolution during the first year of life while accounting for correspondence between functional maturation and cognitive improvement. Full article

More research is needed to understand how the maternal consumption of fish and fish-borne toxicants impacts infant neurodevelopment. The present analysis was conducted over 460 mother–infant pairs within the ECLIPSES study. Dietary intake of metals and persistent organic pollutants from fish (including white fish, blue fish, and seafood) was estimated in pregnant women. The infants underwent cognitive, language, and motor function assessments using the Bayley Scales of Infant Development-III at the 40-day postpartum. Associations between dietary toxicants and outcomes were assessed using multivariable linear regression models. Estimated prenatal exposure to fish-borne toxicants, such as arsenic, inorganic arsenic, methylmercury, dioxin-like polychlorinated biphenyls (DL-PCBs), and non-DL-PCBs, was associated with poorer language functions in infants, whereas no significant associations were found with motor or cognitive functions. Maternal fish consumption exceeding the Spanish recommendation of no more than 71 g per day was linked to these adverse effects on language abilities without affecting motor or cognitive development. This highlights the importance of vigilant monitoring of environmental toxicants and the provision of dietary guidance for pregnant women, with potential implications for public health and child development. Full article

Omega-3 Long-Chain Polyunsaturated Fatty Acids (n-3 LCPUFAs) play a key role in early neurodevelopment, but evidence from observational and clinical studies remains inconsistent. This study investigates the association between maternal n-3 LCPUFA, Docosahexaenoic Acid (DHA), and eicosapentaenoic acid (EPA) concentrations during pregnancy and infant development functioning at 40 days. This study includes 348 mother–infant pairs. Maternal serum concentrations were assessed in the first and third trimesters alongside sociodemographic, clinical, nutritional, psychological, and obstetrical data. At 40 days, the Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III) was administered. An adjusted analysis revealed that lower first-trimester n-3 LCPUFA and DHA concentrations are associated with better infant motor development. These results underscore the potential significance of the maternal n-3 LCPUFA status in early pregnancy for influencing fetal neurodevelopment. However, the complexity of these associations necessitates further investigation, emphasizing the urgent need for additional studies to comprehensively elucidate the nuanced interplay between the maternal n-3 LCPUFA status and infant neurodevelopment. Full article

Metabolic bone disease (MBD) predominantly affects preterm infants, particularly very-low-birth-weight (VLBW) infants weighing <1500 g. However, there are limited reports on MBD and neurodevelopmental outcomes. This study aimed to analyze the risk factors for MBD and understand its impact on neurodevelopmental outcomes at 2 years of corrected age. Overall, 749 VLBW infants weighing <1350 g at birth were enrolled. Exclusion criteria were major congenital abnormalities, chromosomal abnormalities, and loss of follow-up on the Bayley Scales of Infant Development, Third Edition (BSID-III) test at 24 months of corrected age. Infants were retrospectively assessed by a trained case manager using the BSID-III test at 6, 12, and 24 months old. Infants were categorized as with or without MBD according to radiographic signs. Of those enrolled, 97 VLBW infants were diagnosed with MBD, compared to 362 VLBW infants without MBD. The proportion of infants that completed three follow-ups was 86%. At the assessment at 2 years of age, infants with MBD had lower and more significant differences in motor, language, and cognitive composites. MBD is associated with poor neurodevelopmental outcomes in cognitive, motor, and language composites for VLBW infants at 24 months of corrected age. Full article

Background: Severe maternal iodine deficiency has profound consequences for the developing brain; however, the impact of mild to moderate deficiency is less clear, and findings from observational studies have been mixed. Aim: The purpose of this study is to assess the relationship between maternal iodine status in early pregnancy and infant neurological development in an Irish maternal–infant cohort. Methods: Maternal–infant dyads of the Improved Pregnancy Outcomes by Early Detection (IMPROvED) and the Cork Nutrition and Development (COMBINE) cohorts (n 456) were followed during pregnancy and from birth to 2 years of age. Participants completed detailed a clinical and questionnaire-based assessments (including Bayley’s Scale of Infant Development (BSID-III) at 24 months; n 295). Maternal urinary iodine concentration (UIC) was quantified at 15 weeks of gestation by the Sandell–Kolthoff (S-K) method, and urinary creatinine (Cr) was quantified by the Jaffe rate method using the RX Monaco Clinical Chemistry Analyser (Randox Laboratories Ltd.). Statistical analysis was performed using IBM SPSS Version 27 (IBM Corp., Armonk, NY, USA). Results: The median (IQR) maternal age at delivery was 32 (5) years, and the median (IQR) BMI at 15 weeks of gestation was 25.1 (5.0) kg/m². Three-quarters completed third-level education, 95% were in a relationship and 7% were smokers. Median (IQR) UIC was 118 (132) µg/L, and 65% had UIC < 150 µg/L. At 24 months, median (IQR) cognitive, language and motor composite scores were 105 (15), 103 (20) and 103 (14), respectively. Cognitive, language and motor developmental delay was indicated in 6.0, 7.8 and 0.4% of children, respectively. Though a slightly higher prevalence of developmental language delay was observed among infants of mothers with UI:Cr < 150 µg/g for language (11 versus 6%) and a combined cognitive/language outcome (10 versus 4%), when adjusted for education, marital status, gestational age and birthweight, UI:Cr was not associated with language delay (aOR (95% CI): 1.7 (0.6, 4.7)). Among non-users of iodine supplements (29% of sample; median (IQR) UIC: 84 (96) µg/L; 75% < 150 µg/L), for every 10 µg/L increase in UIC, we observed a 23% and 19% reduction in odds of cognitive and language delay, respectively (aOR (95% CI): 0.77 (0.71, 0.97), p = 0.029; 0.81 (0.66, 0.99), p = 0.035). Our findings highlight the importance of sufficient iodine status in early pregnancy. Full article

Infancy is a critical period for neurodevelopment, which includes myelination, synaptogenesis, synaptic pruning, and the development of motor, social-emotional, and cognitive functions. Human milk provides essential nutrients to the infant’s developing brain, especially during the first postnatal months. Human milk oligosaccharides (HMOs) are a major component of human milk, and there is growing evidence of the association of individual HMOs with cognitive development in early life. However, to our knowledge, no study has explained these associations with a mechanism of action. Here, we investigated possible mediating associations between HMOs in human milk, brain myelination (measured via myelin water fraction), and measures of motor, language (collected via the Bayley Scales of Infant and Toddler Development (Bayley-III)), and socioemotional development (collected via the Ages and Stages Questionnaire: Social-Emotional Version (ASQ-SE)) in healthy term-born breast-fed infants. The results revealed an association between 6′Sialyllactose and social skills that was mediated by myelination. Furthermore, associations of fucosylated HMOs with language outcomes were observed that were not mediated by myelination. These observations indicate the roles of specific HMOs in neurodevelopment and associated functional outcomes, such as social-emotional function and language development. Full article

Background: Integrating family-centered care (FCC) and developmental care (DC) principles in neonatal care settings may improve neurodevelopmental outcomes for high-risk neonates. However, the combined impact of FCC and DC has been underexplored. This study aimed to investigate the effects of integrated FCC and DC on neurodevelopment and length of hospital stay in high-risk neonates. Methods: A quasi-experimental pre–post study was conducted among 200 high-risk neonates (<32 weeks gestation or <1500 g) admitted to neonatal intensive care units (NICU) in Saudi Arabia. The intervention group (n = 100) received integrated FCC and DC for 6 months. The control group (n = 100) received standard care. Neurodevelopment was assessed using the Bayley Scales of Infant Development-III. Length of stay and readmissions were extracted from medical records. Results: The intervention group showed significant improvements in cognitive, motor, and language scores compared to controls (p < 0.05). The intervention group had a 4.3-day reduction in the mean length of stay versus a 1.4-day reduction in controls (p = 0.02). Integrated care independently predicted higher cognitive scores (p = 0.001) and shorter stays (p = 0.006) in regression models. Conclusion: Integrating FCC and DC in neonatal care enhances neurodevelopmental outcomes and reduces hospitalization for high-risk neonates compared to standard care. Implementing relationship-based, developmentally supportive models is critical for optimizing outcomes in this vulnerable population. Full article

(1) Background: Cerebral MRI plays a significant role in assessing the extent of brain injury in neonates with neonatal encephalopathy after perinatal asphyxia. Over the last decades, several MRI scoring systems were developed to enhance the predictive accuracy of MRI. The aim of this study was to validate the correlation of four established MRI scoring systems with cognitive long-term outcomes in cooled asphyxiated newborns. (2) Methods: Forty neonates with neonatal encephalopathy treated with therapeutic hypothermia were included in this retrospective study. The MRI scans from the second week of life were scored using four existing MRI scoring systems (Barkovich, NICHD, Rutherford, and Weeke). The patients’ outcome was assessed with the Bayley Scales of Infant Development (BSID-III) at the age of 2 years. To evaluate the correlation between the MRI scoring system with the cognitive scores of BSID-III, the correlation coefficient was calculated for each scoring system. (3) Results: All four MRI scoring systems showed a significant correlation with the cognitive scores of BSID-III. The strongest correlation was found between the Weeke Score (r² = 0.43), followed by the Rutherford score (r² = 0.39), the NICHD score (r² = 0.22), and the Barkovich score (r² = 0.17). (4) Conclusion: Our study confirms previously published results in an independent cohort and indicates that the Weeke and Rutherford scores have the strongest correlation with the cognitive score of BSID-III in cooled asphyxiated newborns. Full article

Polyunsaturated fatty acids (PUFAs) are vital for brain development, yet limited knowledge exists regarding PUFA intake during complementary feeding (CF) and its impact on neurodevelopmental outcomes in very low birth weight (VLBW) infants. This secondary analysis of a randomized intervention trial, aimed to investigate the association between dietary intake of total PUFAs, arachidonic acid (AA), and docosahexaenoic acid (DHA) during CF and neurodevelopmental outcomes at 12 and 24 months of corrected age (CA). Dietary intakes were assessed using monthly 3 day dietary protocols from 3 to 12 months CA. Neurodevelopmental outcome was evaluated using the Bayley Scales of Infant Development-III. Among the 177 randomized patients, PUFA intake and neurodevelopmental outcomes were evaluated in 140 (79%) infants. Higher total PUFA and DHA intakes significantly correlated with improved cognitive and motor function at 12 months CA, while increased AA intake notably enhanced motor scores at 12 months CA. However, median dietary intakes of AA and DHA (AA: 53.50–84.25 mg/d; DHA: 51.47–76.23 mg/d) fell short of recommended levels (AA: 140 mg/d; DHA: 100 mg/d) at any of the investigated timepoints. These findings emphasize the need to enhance total PUFA, DHA and AA intakes during CF, ensuring adherence to guidelines and unlocking the potential to improve neurodevelopmental outcomes in VLBW infants. Full article