Developmental Delay in Moderately Preterm-Born Children with Low Socioeconomic Status: Risks Multiply

Potijk, Marieke R; Kerstjens, Jorien M.; Bos, Arend F.; Reijneveld, Sijmen A.; Winter, Andrea F. de

doi:10.1016/j.jpeds.2013.07.001

Cited by 118 publications

(93 citation statements)

References 29 publications

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“…However, that study and most other hypoglycemic outcome studies (except for the study by Lucas et al 8 ) failed to control for maternal educational level and socioeconomic status, factors that are highly associated with childhood neurocognitive outcome and educational performance. [18][19][20][21][22][23] The American Academy of Pediatrics 2011 report on glucose homeostasis acknowledged that screening and management of newborn hypoglycemia is "a controversial issue for which evidence is lacking but guidance is needed." 11(p575) These guidelines are based on expert opinion and lack support from high-quality long-term follow-up studies.…”

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confidence: 99%

Association Between Transient Newborn Hypoglycemia and Fourth-Grade Achievement Test Proficiency

et al. 2015

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IMPORTANCE Prolonged neonatal hypoglycemia is associated with poor long-term neurocognitive function. However, little is known about an association between early transient newborn hypoglycemia and academic achievement.OBJECTIVE To determine if early (within the first 3 hours of life) transient hypoglycemia (a single initial low glucose concentration, followed by a second value above a cutoff) is associated with subsequent poor academic performance. DESIGN, SETTING, AND PARTICIPANTSA retrospective population-based cohort study of all infants born between January 1, 1998, and December 31, 1998, at the University of Arkansas for Medical Sciences who had at least 1 recorded glucose concentration (a universal newborn glucose screening policy was in effect) was conducted. Medical record data from newborns with normoglycemia or transient hypoglycemia were matched with their student achievement test scores in 2008 from the Arkansas Department of Education and anonymized. Logistic regression models were developed to evaluate the association between transient hypoglycemia and school-age achievement test proficiency based on perinatal factors. Common hypoglycemia cutoffs of a glucose level less than 35 mg/dL (primary) and less than 40 and 45 mg/dL (secondary) were investigated. All 1943 normoglycemic and transiently hypoglycemic infants (23-42 weeks' gestation) were eligible for inclusion in the study. Infants with prolonged hypoglycemia, congenital anomalies, or chromosomal abnormalities were excluded from the study. EXPOSURE Hypoglycemia as a newborn. MAIN OUTCOMES AND MEASURESThe primary outcome was proficiency on fourth-grade literacy and mathematics achievement tests at age 10 years. We hypothesized a priori that newborns with early transient hypoglycemia would be less proficient on fourth-grade achievement tests compared with normoglycemic newborns.RESULTS Perinatal data were matched with fourth-grade achievement test scores in 1395 newborn-student pairs (71.8%). Transient hypoglycemia (glucose level <35, <40, and <45 mg/dL) was observed in 6.4% (89 of 1395), 10.3% (143 of 1395), and 19.3% (269 of 1395) of newborns, respectively. After controlling for gestational age group, race, sex, multifetal gestation, insurance status, maternal educational level and socioeconomic status, and gravidity, transient hypoglycemia was associated with decreased probability of proficiency on literacy and mathematics fourth-grade achievement tests. For the 3 hypoglycemia cutoffs, the adjusted odds ratios (95% CIs) for literacy were 0.49 (0.28-0.83), 0.43 (0.28-0.67), and 0.62 (0.45-0.85), respectively, and the adjusted odds ratios (95% CIs) for mathematics were 0.49 (0.29-0.82), 0.51 (0.34-0.78), and 0.78 (0.57-1.08), respectively.CONCLUSIONS AND RELEVANCE Early transient newborn hypoglycemia was associated with lower achievement test scores at age 10 years. Given that our findings are serious and contrary to expert opinion, the results need to be validated in other populations before universal newborn glucose screening should be adopted.

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Association Between Transient Newborn Hypoglycemia and Fourth-Grade Achievement Test Proficiency

et al. 2015

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“…In addition, not only has extreme prematurity led infants to experience delays and sequelae, but moderately preterm infants (32-36 weeks' gestation) have shown delayed motor development when associated with the low socioeconomic status of their families. The economic factor can increase the risk of prematurity and its consequences for an infant's health 20 …”

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Predictive models of early motor development in preterm infants: a longitudinal-prospective study

Formiga

Vieira

Facundes

et al. 2017

J. Hum. Growth Dev.

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Introduction: Preterm infants are vulnerable to developmental delays. Detecting problems at an early age is one of the challenges of professionals and researchers in the area. Objective: To analyse the motor development and to identify the risk factors associated with predictors of overall and motor delay in preterm newborns. Methods: Eighty preterm infants (50% female; mean gestational age = 33 ± 2.2 weeks) with low birth weight (average of 1,715 ± 437 g) were evaluated using the Neurobehavioral Assessment of the Preterm Infant (NAPI) during the neonatal phase (prior to term age), the Denver Developmental Screening Test II (DDST-II) between 2 and 8 months, the Test of Infant Motor Performance between 2 and 4 months regarding motor development and the Alberta Infant Motor Scale between 4 and 8 months. Results: Neurobehavioural delay was noted in 24% of the infants in the neonatal phase. Between 2 and 8 months, the delay in overall development was ≥ 31% and the delay in motor development was 35-36 %. Decreased levels of alertness, orientation, motor development and vigour according to the NAPI were shown to be predictive of a delay in development between 4 and 6 months of age. The delay in overall development between 2 and 6 months was predictive of a delay in motor development between 6 and 8 months. Conclusion: Neurobehavioural variables, hospital stay and overall delay are good predictors of motor development during the first year of age. Suggested citation: Formiga CKMR, Vieira MEB, Fagundes RR, Linhares MBM. Predictive models of early motor development in preterm infants: a longitudinal-prospective study. Keywords

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“…Although the causes of many developmental delays are unknown, factors such as low birth weight, premature birth, birth complications, congenital infections, serious maternal illness during pregnancy, certain inherited conditions, exposure to toxins and family history of developmental delay may increase the risk. 1,[3][4][5][6][7] Clinicians should perform developmental surveillance on an ongoing basis and consider the possibility of developmental delay in children with signs that may suggest a delay in a developmental domain, as well as in those whose parents, caregivers or clinicians have concerns about development and those with important risk factors. Clinicians should remain alert for any social, economic or environmental factors (such as lower maternal education level, mental illness, neglect or maltreatment, poverty and English as a second language) that might reduce the likelihood of parents to raise concerns about their child's development.…”

Section: Considerations For Implementationmentioning

confidence: 99%

“…Clinicians should remain alert for any social, economic or environmental factors (such as lower maternal education level, mental illness, neglect or maltreatment, poverty and English as a second language) that might reduce the likelihood of parents to raise concerns about their child's development. 1,[3][4][5][6][7] Among children in whom developmental delay is suspected, clinicians should consider further assessment (or specialist evaluation) as clinically indicated. A recommendation against population-based screening for developmental delay should facilitate these objectives by reducing potentially unnecessary referrals to specialists and increasing access to specialized services for children who have clinically evident developmental delay.…”

Section: Considerations For Implementationmentioning

confidence: 99%

“…2,3 Many factors are associated with increased risk of developmental delay, including poor maternal health during pregnancy, birth complications, infections, genetic characteristics, exposure to toxins, trauma, maltreatment and possibly low socioeconomic status. 1,[3][4][5][6][7] There is considerable interest in the possibility that early identification and intervention may improve health outcomes among children with developmental delay. 1,8,9 Population-based screening of all preschool children has been proposed to facilitate early identification and treatment.…”

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confidence: 99%

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Recommendations on screening for developmental delay

2016

CMAJ

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Developmental Delay in Moderately Preterm-Born Children with Low Socioeconomic Status: Risks Multiply

Cited by 118 publications

References 29 publications

Association Between Transient Newborn Hypoglycemia and Fourth-Grade Achievement Test Proficiency

Association Between Transient Newborn Hypoglycemia and Fourth-Grade Achievement Test Proficiency

Predictive models of early motor development in preterm infants: a longitudinal-prospective study

Recommendations on screening for developmental delay

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