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We previously found that atypical responses to the knee jerk reflex, i.e., tonic responses (TRs), clonus and contralateral responses in very high-risk (VHR) infants were associated with cerebral palsy (CP) at 21 months. The current study aimed for a better understanding of pathophysiology of atypical knee jerk responses by evaluating whether infant atypical knee jerk responses are associated with CP and atypical knee jerk responses at school-age. 31 VHR-children, who had also been assessed longitudinally during infancy, and 24 typically developing children, were assessed at 7–10 years (school-age). We continuously recorded surface EMG of thigh muscles during knee jerk responses longitudinally during infancy and once at school-age. Neurological condition was assessed with age-appropriate neurological examinations. It included the diagnosis of CP at 21 months corrected age and school-age. CP's type and severity (Gross Motor Function Classification System (GMFCS)) were reported. Persistent TRs in infancy were associated with CP at school-age. TR prevalence decreased from infancy to childhood. At school-age it was no longer associated with CP. Clonus prevalence in VHR-children did not change with increasing age; it was significantly higher in children without than those with CP. Reflex irradiation was common in all school-age children, and its prevalence in contralateral muscles in VHR-children decreased between infancy and childhood. In infancy, TRs indicated an increased risk of CP, but at school-age TRs were not associated with CP. In general, spinal hyperexcitability, expressed as reflex irradiation and TRs, decreased between infancy and school-age. • Infant tonic knee jerk responses were associated with CP at school-age. • Prevalence of tonic knee jerk response in VHR-infants decreased with increasing age. • Tonic knee jerk responses at school-age were not associated with CP. • In our study group, clonus at school-age occurred mainly in VHR-children without CP. • At school-age, reflex irradiation occurred in VHR- and typically developing children. [ABSTRACT FROM AUTHOR]

To assess the prevalence and development of muscle tone impairments in infants at high risk of developmental disorders, and their associations with cerebral palsy (CP) and cystic periventricular leukomalacia (cPVL). Longitudinal exploration of muscle tone in 39 infants at high risk of CP (LEARN2MOVE 0–2 project) mostly due to an early lesion of the brain. Muscle tone was assessed ≥4 times between 0 and 21 months corrected age (CA) with the Touwen Infant Neurological Examination. Diagnosis of CP was determined at 21 months CA. Neonatal neuro-imaging was available. Developmental trajectories were calculated using generalized linear mixed effect models. Infants showed atypical muscle tone in three or four body parts in 93% (172/185) of the assessments. The most prevalent muscle tone pattern was hypotonia of neck and trunk with hypertonia of the limbs (28%). From 7 months CA onwards hypertonia of the arms was associated with CP. Asymmetric arm tone during infancy was associated with unilateral CP. At 18–21 months CA ankle hypertonia was associated with CP at 21 months; leg hypertonia in infancy was not associated with CP. Leg hypertonia was associated with cPVL, regardless of age. High-risk infants due to an early lesion of the brain often present with muscle tone impairment. In these infants, hypertonia and asymmetric muscle tone of the arms were from 7 months onwards associated with the diagnosis of CP at 21 months; hypertonia of the legs was not. • High-risk infants have a high prevalence of muscle tone impairments (>90%). • Axial hypotonia with limb hypertonia is most common pattern in high-risk infants. • From 7 months onwards arm hypertonia was associated with CP. • Asymmetrical muscle tone of the arms was associated with unilateral CP. • Hypertonia of the legs was associated with cPVL. [ABSTRACT FROM AUTHOR]

• Prenatal activity shapes the newborn's ability to perceive face and gaze signals. • Perception of face identity, expression and gaze is highly context specific. • Race and culture represent contexts involving experience and social categorization. • Processing of face and gaze occurs in interacting subcortical and cortical pathways. • Processing of face and gaze involves a bottom-up and top-down flow of information. This review summarizes human perception and processing of face and gaze signals. Face and gaze signals are important means of non-verbal social communication. The review highlights that: (1) some evidence is available suggesting that the perception and processing of facial information starts in the prenatal period; (2) the perception and processing of face identity, expression and gaze direction is highly context specific, the effect of race and culture being a case in point. Culture affects by means of experiential shaping and social categorization the way in which information on face and gaze is collected and perceived; (3) face and gaze processing occurs in the so-called 'social brain'. Accumulating evidence suggests that the processing of facial identity, facial emotional expression and gaze involves two parallel and interacting pathways: a fast and crude subcortical route and a slower cortical pathway. The flow of information is bi-directional and includes bottom-up and top-down processing. The cortical networks particularly include the fusiform gyrus, superior temporal sulcus (STS), intraparietal sulcus, temporoparietal junction and medial prefrontal cortex. [ABSTRACT FROM AUTHOR]

To evaluate the effect of 15° forward (FW) seat inclination and foot-support in children with cerebral palsy (CP) on postural adjustments during reaching. Observational study repeated-measures design; step two of two-step-project. Laboratory unit within University Hospital and two special education schools. 19 children (ten unilateral spastic CP (US-CP); nine bilateral spastic CP (BS-CP); Gross Motor Function Classification System levels I-III; 6–12 years old). Participants were able to take part for one one-hour session. Reaching while sitting in four seating conditions (FW or horizontal seat; with or without foot-support) applied in randomized order. Simultaneously, surface electromyography (EMG) of neck, trunk and arm muscles and kinematics of head and reaching arm (step one of two-step-project) were recorded. Primary outcome parameters were the ability to modulate EMG-amplitudes at baseline and during reaching (phasic muscle activity). Other EMG-parameters were direction-specificity (1st control level), and 2nd level of control parameters: recruitment order, and anticipatory postural activity. Motor behaviour measures: ability to modulate EMG-amplitudes to kinematic characteristics of reaching and head stability. Only foot-support was associated with increased tonic background EMG-amplitudes and decreased phasic EMG-amplitudes of the trunk extensors in children with US-CP and BS-CP (mixed-models analyses; p-values <0.01). The foot-support effect was also associated with better kinematics of reaching (Spearman's Rho; p-values <0.01). In terms of postural adjustments during forward reaching, foot-support enhanced the children's capacity to modulate trunk extensor activity, which was associated with improved reaching quality. FW-tilting did not affect postural muscle activity. • FW seat inclination does not affect postural EMG of reaching children with CP. • Foot-support in seated children with CP increases tonic trunk extensor activity regardless of CP type or seat inclination. • Increased tonic trunk extensor activity was associated with improved kinematics of reaching. [ABSTRACT FROM AUTHOR]

This review summarizes early human brain development on the basis of neuroanatomical data and functional connectomics. It indicates that the most significant changes in the brain occur during the second half of gestation and the first three months post-term, in particular in the cortical subplate and cerebellum. As the transient subplate pairs a high rate of intricate developmental changes and interactions with clear functional activity, two phases of development are distinguished: a) the transient cortical subplate phase, ending at 3 months post-term when the permanent circuitries in the primary motor, somatosensory and visual cortices have replaced the subplate; and subsequently, b) the phase in which the permanent circuitries dominate. In the association areas the subplate dissolves in the remainder of the first postnatal year. During both phases developmental changes are paralleled by continuous reconfigurations in network activity. The reviewed literature also suggests that disruption of subplate development may play a pivotal role in developmental disorders, such as cerebral palsy, autism spectrum disorders, attention deficit hyperactivity disorder and schizophrenia. [ABSTRACT FROM AUTHOR]

This review summarizes early human motor development. From early fetal age motor behavior is based on spontaneous neural activity: activity of networks in the brainstem and spinal cord that is modulated by supraspinal activity. The supraspinal activity, first primarily brought about by the cortical subplate, later by the cortical plate, induces movement variation. Initially, movement variation especially serves exploration; its associated afferent information is primarily used to sculpt the developing nervous system, and less to adapt motor behavior. In the next phase, beginning at function-specific ages, movement variation starts to serve adaptation. In sucking and swallowing, this phase emerges shortly before term age. In speech, gross and fine motor development, it emerges from 3 to 4 months post-term onwards, i.e., when developmental focus in the primary sensory and motor cortices has shifted to the permanent cortical circuitries. With increasing age and increasing trial-and-error exploration, the infant improves its ability to use adaptive and efficicient forms of upright gross motor behavior, manual activities and vocalizations belonging to the native language. [ABSTRACT FROM AUTHOR]

Longer gestation at term and post-term age is associated with increased perinatal mortality. Nonetheless, recent neuroimaging studies indicated that longer gestation is also associated with better functioning of the child's brain. to assess whether longer gestation in term and post-term (in short: term) singletons is associated with better infant neurodevelopment. cross-sectional observational study. Participants were all singleton term infants (n = 1563) aged 2–18 months of the IMP-SINDA project that collected normative data for the Infant Motor Profile (IMP) and Standardized Infant NeuroDevelopmental Assessment (SINDA). The group was representative of the Dutch population. Total IMP score was the primary outcome. Secondary outcomes were atypical total IMP scores (scores <15th percentile) and SINDA's neurological and developmental scores. Duration of gestation had a quadratic relationship with IMP and SINDA developmental scores. IMP scores were lowest at a gestation of 38·5 weeks, SINDA developmental scores at 38·7 weeks. Next, both scores increased with increasing duration of gestation. Infants born at 41–42 weeks had significantly less often atypical IMP scores (adjusted OR [95 % CI]: 0·571 [0·341–0·957] and atypical SINDA developmental scores (adjusted OR: 0·366 [0·195–0·688]) than infants born at 39–40 weeks. Duration of gestation was not associated with SINDA's neurological score. In term singleton infants representative of the Dutch population longer gestation is associated with better infant neurodevelopment scores suggesting better neural network efficiency. Longer gestation in term infants is not associated with atypical neurological scores. • Longer gestation at term is associated with better Infant Motor Profile scores. • Longer gestation at term is associated with better SINDA developmental scores. • Longer gestation at term is not associated with SINDA neurological scores. [ABSTRACT FROM AUTHOR]

Abstract: Background: Children with unilateral congenital below elbow deficiency (UCBED) lack a part of an arm, thereby lacking a part of the typical hand function. Little is known on the performance of daily activities in very young children with UCBED, usage of their affected arm with or without prosthesis during play, and neurological condition. Aim: To explore daily activities, the use of the affected limb with or without prosthesis and neurological condition over time in young children with UCBED. Design: A longitudinal observational multiple case study. Methods: Four children with UCBED were assessed (first assessment at 3–16months) every 6–8months (follow-up 13–49months) with a video-recorded, standardized play session and a neurological examination. Yearly, functioning in daily activities was evaluated using the Pediatric Evaluation of Disability Inventory — Dutch Version (PEDI-NL). Play behaviour was assessed with and without prosthesis, where applicable (n=2). Video-analysis focused on achievement, exploration, variation and adaptability of the affected limb. Behavioural changes over time were plotted and analysed visually. Results: Over time, children with UCBED showed efficient usage of their affected arm during spontaneous play. Prosthesis use seemed to be associated with reduced manipulation, exploration, variation and adaptation. Three children showed minor neurological dysfunction. Functioning in daily activities was comparable to a norm population. Conclusion: The short limb of children with UCBED is used as an exploratory, manipulatory and fixating tool from the beginning of infancy. Its value seems to be reflected in these children''s normal functioning in daily life. Prosthetic use may lead to less effective performance. [Copyright &y& Elsevier]

It takes >20 y before the human brain obtains its complex adult configuration. Most dramatic neurodevelopmental changes occur prenatally and early postnatally, including a major transformation in cortical organization 3-4 mo after term. The long-lasting changes have practical implications for studies evaluating the effect of prenatal and early postnatal supplementation with long-chain polyunsaturated fatty acids (LC-PUFAs). Whether studies of the effect of supplementation will reveal an effect not only depends on the dosage and duration of supplementation but also on 1) the timing of supplementation, 2) the age at which the outcome is assessed, 3) the application of age-specific sensitive neurodevelopmental tools, and 4) the functional domain evaluated. Studies of the effects of prenatal supplementation with docosahexaenoic acid (DHA) or fish oil have provided inconsistent results. However, maternal and neonatal concentrations of DHA and arachidonic acid are associated with improved outcomes in early infancy, and concentrations of DHA are associated with favorable neurodevelopmental outcome beyond early infancy. Studies of LC-PUFA supplementation in preterm infants have not shown evidence of a positive effect on neurodevelopmental outcome. Similar studies in full-term infants have indicated that supplementation with 0.30% DHA (by wt) promotes neurodevelopmental outcome in early infancy, but positive effects on later outcome have not been shown. However, information on the effects on outcomes at school age or later is virtually absent. This article stresses the need for long-term longitudinal studies that apply age-specific, sensitive neurodevelopmental tools, which also take into account lifestyle habits, maternal prepregnancy nutritional status, and genetic variation in metabolism. [ABSTRACT FROM AUTHOR]

Beneficial effects of perinatal DHA supply on later neurological development have been reported. We assessed the effects of maternal DHA supplementation on the neurological development of their children. Healthy pregnant women from Spain, Germany, and Hungary were randomly assigned to a dietary supplement consisting of either fish oil (FO) (500 mg/d DHA + 150 mg/d EPA), 400 μg/d 5-methyltetrahydrofolate, both, or placebo from wk 20 of gestation until delivery. Fatty acids in plasma and erythrocyte phospholipids (PL) were determined in maternal blood at gestational wk 20 and 30 and in cord and maternal blood at delivery. Neurological development was assessed with the Hempel examination at the age of 4 y and the Touwen examination at 5.5 y. Minor neurological dysfunction, neurological optimality score (NOS), and fluency score did not differ between groups at either age, but the odds of children with the maximal NOS score increased with every unit increment in cord blood DHA level at delivery in plasma PL (95% Cl: 1.094-2.262), erythrocyte phosphatidylethanolamine (95% Cl: 1.091-2.417), and erythrocyte phosphatidylcholine (95% Cl: 1.003-2.643). We conclude that higher DHA levels in cord blood may be related to a better neurological outcome at 5.5 y of age. [ABSTRACT FROM AUTHOR]

Abstract: Docosahexaenoic acid (DHA) and arachidonic acid (AA) are important for neurodevelopment. The effects of DHA (220mg/day, n=41), DHA+AA (220mg/day, n=39) or placebo (n=34) during pregnancy and lactation on neurodevelopment at 18 months, and the relations between umbilical cord DHA, AA and Mead acid and neurodevelopment were studied. An age-specific, standardized neurological assessment for the evaluation of minor neurological dysfunction (MND), and the Bayley Scales of Infant Development (BSID) were used. The intervention did not influence any of the outcomes. Umbilical venous (UV) Mead acid was negatively and n-6 fatty acids were weakly positively associated to the BSID mental developmental index. Children with simple MND had lower UV DHA compared to normally classified children. We conclude that relatively short-term maternal DHA or DHA+AA supplementation does not influence neurodevelopment at toddler age, although some parameters of brain development are related to perinatal DHA and AA status. [Copyright &y& Elsevier]

Abstract: Background: General movements (GMs) form the basic motility of young infants. The quality of GMs may predict neurological outcome, but little is known about relationships between GM-quality and behavioral problems, including those resulting in overt psychiatric morbidity. Aim: To explore relationships between abnormal GMs and behavioral problems, in particular relationships between abnormal GMs and Attention Deficit Hyperactivity Disorder (ADHD) with or without psychiatric co-morbidity at school-age. Methods: Twenty-five low-risk full term infants and 16 infants at high risk for neurodevelopmental disorder but without cerebral palsy were studied prospectively. GM-quality was assessed during ‘writhing’ age (around term till 2 months post-term) and ‘fidgety’ age (2–4 months post-term). GMs were classified into normal and abnormal movements. When the children were 9–12 years, parents completed the Child Behavior Checklist (CBCL) and provided information on the presence of psychiatric diagnoses; teachers completed the Teachers Report Form (TRF). Both parents and teachers completed a questionnaire on ADHD-like behavior. Results: Abnormal GMs at ‘writhing’ and ‘fidgety’ age were related to the presence of ADHD with psychiatric co-morbidity (p <0.05), but not to isolated ADHD. Abnormal GMs at ‘fidgety’ age were weakly related to problematic behavior at school (TRF-scores) and hyperactive behavior at home (ADHD-questionnaire). Conclusions: This explorative study suggests that abnormal GMs in early infancy may be associated with an increased risk for behavioral problems, in particular for ADHD with psychiatric co-morbidity at school-age. [Copyright &y& Elsevier]

Abstract: Introduction: Docosahexaenoic acid (DHA) and arachidonic acid (AA) are important for neurodevelopment. Maternal diet influences milk DHA, whereas milk AA seems rather constant. We investigated milk AA, DHA and DHA/AA after supplementation of AA plus DHA, or DHA alone during pregnancy and lactation. Subjects and methods: Women were supplemented with AA+DHA (220mg each/day), DHA (220mg/day) or placebo during pregnancy and lactation. Milk samples were collected at 2 (n=86) and 12 weeks (n=69) postpartum. Results: Supplementation of AA+DHA elevated milk AA (week 2, 14%; week 12, 23%) and DHA (43% and 52%) as compared to placebo. DHA tended to decrease milk AA and vice versa. Milk AA, DHA and DHA/AA decreased from 2 to 12 weeks postpartum. Conclusions: Milk AA and in particular DHA are sensitive to maternal supplementation. It seems that maternal AA and notably DHA status decline with advancing lactation. [Copyright &y& Elsevier]

Background: Previously it had been had reported that active head lifting from supine (AHLS) in high-risk infants was associated with lower cognitive scores in the second year. AHLS was generally accompanied by stereotyped leg movements.Aims: To examine in a standardized way whether AHLS with or without stereotyped leg movements in the general population is associated with prenatal, perinatal, neonatal and socio-economic risk factors or with lower scores on concurrent infant tests.Study Design: Cross-sectional study SUBJECTS: 1700 infants aged 2-18 months representative of the Dutch population.Outcome Measures: Infant Motor Profile (IMP) and Standardized Infant NeuroDevelopmental Assessment (SINDA). Assessments were video-recorded and included at the youngest ages 3min of behaviour in supine. AHLS and the presence of stereotyped leg movements were recorded. Standardized information on early risk factors was available.Results: AHLS occurred at 4-9 months (prevalence per months: 1-14%; highest prevalence at 6 months). It was not associated with early risk factors or scores on infant tests. When AHLS was accompanied by stereotyped leg movements it was associated with a higher prevalence of an IMP-variation score < P15 (Odds Ratio (OR) 2.472 [95%CI 1.017; 6.006]). Stereotyped leg movements irrespective of AHLS were associated with more unfavourable total IMP scores and IMP performance scores (B coefficients -3.212 [-4.065; -2.360], -2.521 [-3.783; -1.259]) and IMP variation and SINDA neurological scores (ORs 5.432 [3.409; 8.655], 3.098 [1.548; 6.202]).Conclusions: The data suggest that AHLS is not a red flag. Rather its co-occurring stereotyped leg movements may signal less favourable neurodevelopment. [ABSTRACT FROM AUTHOR]

Abstract: Interest in the Touwen examination (1979) for the assessment of minor neurological dysfunction (MND) is growing. However, information on psychometric properties of this assessment is scarce. Therefore the present study aimed at assessing the test''s test–retest, inter- and intra-assessor reliability. Eleven boys and 14 girls, visiting a mainstream school, aged 4–12 years, were tested neurologically by 3 investigators. Inter- and intra-assessor reliability were based on videotapes of the assessments. To determine test–retest reliability children were re-assessed after about 1 month. The various forms of reliability were calculated for neurological classification (normal, simple MND, complex MND), clusters of dysfunction and single items. Twelve girls and 7 boys showed a normal neurological condition; 2 girls and 1 boy were classified as having simple MND and 3 boys as having complex MND. The 3 forms of reliability for neurological classification were good (κ=0.71–0.83). Reliability for the majority of cluster scores was good. Test–retest agreement was moderate for the clusters reflexes and coordination and poor for fine manipulation; inter-assessor agreement was moderate for the clusters coordination and fine manipulation; intra-assessor agreement moderate for fine manipulation. Reliability for the majority of items was good. In conclusion, the Touwen examination has a moderate to good reliability when applied in a relatively healthy population. Whether reliability is similarly good in populations of children with minor developmental disorders has to be determined. [Copyright &y& Elsevier]

Abstract: Haga N, van der Heijden-Maessen HC, van Hoorn JF, Boonstra AM, Hadders-Algra M. Test-retest and inter- and intrareliability of the Quality of the Upper-Extremity Skills Test in preschool-age children with cerebral palsy. Objective: To investigate the test-retest, inter-, and intraobserver reliability of the Quality of Upper Extremity Skills Test (QUEST) in young children with cerebral palsy (CP). Design: For test-retest reliability, a test-retest design was used; for the intra- and interobserver reliability, the videotaped test was scored on 2 occasions by 1 observer and by various observers. Setting: Groups of preschool-age children in 2 general rehabilitation centers. Participants: Twenty-one children with CP (12 boys, 9 girls) aged 2 to 4.5 years (mean, 39mo). Interventions: Not applicable. Main Outcome Measure: Spearman correlation coefficient. Results: The data indicated that test-retest reliability was strong (ρ range, .85–.94). Intraobserver agreement (ρ range, .63–.95) and agreement between various observers (ρ range, .72–.90) were moderate to strong. Conclusions: Test-retest and inter- and intraobserver reliability of the QUEST in preschool-age children with CP is good. [Copyright &y& Elsevier]

Abstract: During the last decade it has become clear that the assessment of the quality of general movements (GMs) in foetus and young infant is a sensitive tool to evaluate the integrity of the young nervous system. GMs are movements in which all parts of the body participate. The hallmark of typical GMs is movement complexity and variation; in abnormal GMs movement complexity and variation is reduced or absent. Abnormal GMs may predict developmental outcome. Prediction on the basis of longitudinal series of GM assessments is best. Second best is prediction on the basis of an assessment at ‘fidgety’ GM age, i.e. at 2–4 months post-term. Definitely abnormal GMs at ‘fidgety’ age are related to cerebral palsy, mildly abnormal GMs to minor neurological dysfunction at school age. In the present paper the hypothesis is advanced that GM complexity and variation are brought about by the transiently present cortical subplate and that abnormal GMs are the result of damage or dysfunction of the subplate and its efferent motor connections in the periventricular white matter. [Copyright &y& Elsevier]

Abstract: Homo sapiens has evolved on a diet rich in alpha-linolenic acid and long chain polyunsaturated fatty acids (LCP) . We have, however, gradually changed our diet from about 10,000 years ago and accelerated this change from about 100 to 200 years ago. The many dietary changes, including lower intake of ω3-fatty acids, are related to ‘typically Western’ diseases. After a brief introduction in essential fatty acids (EFA), LCP and their functions, this contribution discusses our present low status of notably LCPω3 in the context of our rapidly changing diet within an evolutionary short time frame. It then focuses on the consequences in pregnancy, lactation and neonatal nutrition, as illustrated by some recent data from our group. We discuss the concept of a ‘relative’ EFA/LCP deficiency in the fetus as the outcome of high transplacental glucose flux. This flux may in the fetus augment de novo synthesis of fatty acids, which not only dilutes transplacentally transported EFA/LCP, but also causes competition of de novo synthesized oleic acid with linoleic acid for delta-6 desaturation. Such conditions were encountered by us in mothers with high body mass indices, diabetes mellitus and preeclampsia. The unifying factor might be compromised glucose homeostasis. In search of the milk arachidonic acid (AA) and docosahexaenoic acid (DHA) contents of our African ancestors, we investigated women in Tanzania with high intakes of freshwater fish as only animal lipid source. These women had milk AA and DHA contents that were well above present recommendations for infant formulae. Both studies stimulate rethinking of ‘optimal homeostasis’. Subtle signs of dysbalanced maternal glucose homeostasis may be important and observations from current Western societies may not provide us with an adequate basis for dietary recommendations. [Copyright &y& Elsevier]

Abstract: The present paper reviews current data on the structural development of the human nervous system. Focus is on the timing of ontogenetic events in the telencephalon. Neuronal proliferation and migration especially occur during the first half of gestation; the second half of gestation is the period of the existence of the functionally important transient structure ‘subplate’ and the major period of glial cell proliferation and programmed cell death. Axon and dendrite sprouting and synapse formation bloom during the last trimester of gestation and the first postnatal year. Major part of telencephalic myelination occurs during the first year after birth. Many developmental processes, such as myelination, synapse formation and synapse elimination continue throughout childhood and adolescence. Evidence is emerging that the peak of synapse elimination occurs between puberty and the onset of adulthood. Neurotransmitter systems are present from early foetal life onwards and their pre- and perinatal development is characterized by periods of transient overexpression. The latter is for instance true for the acetylcholinergic, catecholaminergic and glutamate systems. Thus, the development of the human brain is characterized by a protracted, neatly orchestrated chain of specific ontogenetic events. The continuous changes of the nervous system have consequences for vulnerability to adverse conditions, for diagnostics and for physiotherapeutical intervention. [Copyright &y& Elsevier]

Background: Whether long-chain polyunsaturated fatty acids (LCPs) play a role in the development of the young nervous system in term infants is debated. Objective: We investigated whether supplementation of formula with LCPs for 2 mo improves the quality of general movements (GMs) in healthy term infants at 3 mo of age. Design: A prospective, double-blind, randomized controlled study was conducted with 2 groups of healthy term infants: a controlformula (CF) group (n = 131) and an LCP-supplemented-formula (LF) group (n = 119). A breastfed (BF) group (n = 147) served as a reference. Information on potential confounders was collected at enrollment. Videotapes were made of the infants' spontaneous motor behavior at 3 mo of age to assess the quality of their GMs. On the basis of quality, normal GMs were classified as normal-optimal or normal-suboptimal, and abnormal GMs were classified as mildly or definitely abnormal. Attrition at 3 mo of age was 15% and nonselective. Multivariate regression analyses with adjustment for confounders were carried out to evaluate the effect of the type of feeding. Results: None of the infants had definitely abnormal GMs. Infants in the CF group had mildly abnormal GMs significantly more often than did infants in the LF and BF groups (31% compared with 19% and 20%, respectively). Infants in the BF group had normal-optimal GMs more frequently than did infants in the LF and CF groups (34% compared with 18% and 21%, respectively). Logistic regression analyses confirmed these findings. Conclusion: Supplementation of healthy term infants with LCPs during the first 2 mo of life reduces the occurrence of mildly abnormal GMs. [ABSTRACT FROM AUTHOR]

Application of the concepts of the Neuronal Group Selection Theory (NGST) may shed a new light on motor development. According to NGST, normal motor development is characterized by two phases of variability. Variation is not random, but determined by criteria set by genetic information. Development starts with the phase of primary variability, during which variation in motor behavior is not geared to external conditions. At function-specific ages secondary variability starts, during which motor performance can be adapted to specific situations. In both forms of variability selection on the basis of afferent information plays a significant role. From the NGST point of view, children with pre- or perinatally acquired brain damage suffer from stereotyped motor behavior produced by a limited repertoire of primary (sub)cortical neuronal networks. These children also have problems in selecting the most efficient neuronal activity due to deficits in the processing of sensory information. [Copyright &y& Elsevier]

Abstract: Evidence is accumulating that abundance in cerebral connectivity is the neural basis of human behavioural variability, i.e., the ability to select adaptive solutions from a large repertoire of behavioural options. Recently it was demonstrated that variability in motor behaviour – the hallmark of typical development – emerges coincident with the onset of synaptic activity in the embryonic cortex. This inspired the hypothesis that variability results from cortical activity and that its expression depends on integrity of cortical connectivity. Recent findings in preterm infants with cerebral white matter injury and in children with autism spectrum disorder (ASD) allow the elaboration of this hypothesis: diffuse damage of the cerebral white matter is associated with an overall reduction in variability, i.e., in a reduction of movement complexity and variation, whereas reduction in long-distance cortical connectivity, as described in children with ASD, is associated with reduced variability, in which movement complexity may be conserved. [Copyright &y& Elsevier]

Abstract: Low status of long-chain polyunsaturated fatty acids (LCP) and essential fatty acids (EFA) in the fetus is associated with less favorable neonatal neurological condition. A ‘relative’, rather than ‘absolute’ EFA deficiency might explain this finding. A relative EFA deficiency may derive from impaired maternal glucose homeostasis. We measured fatty acids in umbilical vessels of infants born to 7 mothers with (gestational) diabetes mellitus and of 258 infants born to healthy mothers. Umbilical veins of infants of diabetic mothers had higher ω7 and ω9 fatty acids and DHA deficiency index and lower 20:4ω6 and EFA index. Their umbilical arteries had higher ω7 and ω9 fatty acids, and lower 20:4ω6, LCP and EFA index. We conclude that children born to mothers with poor glucose homeostasis have lower EFA and LCP status, which is consistent with a ‘relative deficiency’ deriving from augmented de novo fatty acid synthesis from the abundant glucose. [Copyright &y& Elsevier]

Background: Assessing the quality of general movements (GMs) is a non-invasive tool to identify at early age infants at risk for developmental disorders.Aim: To investigate whether specific characteristics of definitely abnormal GMs are associated with developmental outcome at school age.Study Design: Observational cohort study (long-term follow-up).Subjects: Parents of 40 children (median age 8.3 years, 20 girls) participated in this follow-up study. In infancy (median corrected age 10 weeks), the children (median gestational age 30.3 weeks; birth weight 1243 g) had shown definitely abnormal GMs according to Hadders-Algra (2004). Information on specific GM characteristics such as the presence of fidgety movements, degree of complexity and variation, and stiff movements, was available (see Hamer et al. 2011).Outcome Measures: A standardised parental interview (presence of CP, attendance of school for special education, Vineland Adaptive Behavior Scale to determine functional performance) and questionnaires (Developmental Coordination Disorder Questionnaire [DCD-Q] to evaluate mobility and Child Behavior Checklist to assess behaviour) were used as outcome measures.Results: Six children had cerebral palsy (CP), ten children attended a school for special education, and eight children had behavioural problems. Both the absence of fidgety movements and the presence of stiff movements were associated with CP (p=0.001; p=0.003, respectively). Stiff movements were also related to the need of special education (p=0.009). A lack of movement complexity and variation was associated with behavioural problems (p=0.007). None of the GM characteristics were related to DCD-Q scores.Conclusions: The evaluation of fidgety movements and movement stiffness may increase the predictive power of definitely abnormal GMs for motor outcome--in particular CP. This study endorses the notion that the quality of GMs reflects the integrity of the infant's brain, assisting prediction of long-term outcome. [ABSTRACT FROM AUTHOR]

Background Some evidence suggests that children with specific behavioral problems are at risk for motor problems. It is unclear whether neurological condition plays a role in the propensity of children with behavioral problems to develop motor problems. Aims To examine the relation between behavioral problems, motor performance and neurological condition in school-aged children. Study design Cross-sectional study. Subjects 174 children (95 boys) receiving mainstream education and 106 children (82 boys) receiving special education aged 6 to 13 years (mean 9 y 7 m, SD 1 y 10 m). Outcome measures Behavior was assessed with questionnaires: the parental Child Behavior Checklist (CBCL) and Teacher's Report Form (TRF). Motor performance was assessed with the Movement Assessment Battery for Children (MABC). MABC-scores ≥ 5th percentile were considered as age-adequate and scores < 5th percentile indicated definite motor problems. Neurological condition was assessed in terms of Minor Neurological Dysfunction (MND). Results The majority of specific behavioral problems were associated with definite motor problems, except somatic complaints and rule breaking behavior. Children with externalizing problems, according to the CBCL or TRF, and motor problems had more often MND than children with externalizing problems only. The same holds true for internalizing problems according to the CBCL. Conclusions The present study demonstrated that various forms of behavioral problems were associated with motor problems. Especially children with motor and behavioral problems showed MND. [ABSTRACT FROM AUTHOR]

Abstract: Background: In children with developmental disorders, motor problems often co-occur with cognitive difficulties. Associations between specific cognitive deficits underlying learning problems and minor neurological dysfunction (MND) are still unknown. Aims: To assess associations between specific types of MND as clinical markers of non-optimal brain function and performance in specific cognitive domains. Study design: Part of a randomized controlled trial. Subjects: Three hundred and forty one 9-year-old children born at term (177 boys, 164 girls). Outcome measures: Children were neurologically assessed to detect eight types of MND: mild dysfunction in posture and muscle tone, reflexes, coordination, fine manipulative ability, sensory function, cranial nerve function, choreiform dyskinesia and excessive associated movements. Cognitive function in the domains of attention, memory and language was evaluated using the Test of Everyday Attention for Children (TEA-Ch), a developmental neuropsychological assessment (NEPSY) and the Children''s Memory Scale. Results: Fine manipulative disability and coordination problems were associated with lower scores on attention, memory and learning and language, other types of MND were not. Girls with coordination problems performed significantly worse on attention/executive function than those without this dysfunction; however, in boys, such association was absent. Conclusion: Particularly, fine manipulative disability and coordination problems were associated with worse cognitive function in the domains of attention, learning and memory and language. Previous and present data suggest a minor sex difference in neurocognitive associations: in girls dysfunction of the cerebello-thalamo-cortical pathways may be associated with cognitive deficits, while in boys cognitive impairment may be associated with dysfunction of cortico-striato-thalamo-cortical pathways. [Copyright &y& Elsevier]

Abstract: Background: Parental anxiety and stress may have consequences for infant neurological development. Aims: To study relationships between parental anxiety or well-being and infant neurological development approximately one year after birth. Study design: Longitudinal study of a birth cohort of infants born to subfertile couples. Subjects: 206 parent–child dyads. Outcome measures: Infant neurology was assessed with the Touwen Infant Neurological Examination (TINE) at 10months and a developmental questionnaire at 12months. Parental measures included trait anxiety measured by the State-Trait Anxiety Inventory (STAI) and well-being measured by the General Health Questionnaire (GHQ). Results: Maternal trait anxiety was associated with a less optimal neurological condition (r s =−0.19, p <0.01) of the infant. This association persisted after adjusting for confounders and results were confirmed by the outcome of the developmental questionnaire. Paternal trait anxiety and parental well-being were not related to the infant''s neurodevelopmental outcome. Conclusions: Infants of mothers with high trait anxiety have an increased vulnerability to develop a non-optimal nervous system. The association may be mediated in part by early programming of monoaminergic systems. Future research should include an exploration of specific windows of vulnerability to maternal anxiety. [Copyright &y& Elsevier]

In vitro fertilization (IVF) is not associated with neurological abnormalities in offspring's early childhood. Yet, it is unclear whether this is also true for school age. Neither do we know the role of parental subfertility in offspring's neurological development. The present study examined neurological condition at 9 years of 57 singletons born after controlled ovarian hyperstimulation IVF (COH-IVF), 46 singletons born after modified natural cycle IVF (MNC-IVF) and 66 singletons born to subfertile parents after natural conception (Sub-NC). To assess the effect of subfertility, the groups were pooled to form a subfertile group, and compared with a prospectively followed fertile reference group (n = 282). The sensitive Minor Neurological Dysfunction (MND) examination was used, resulting in the detailed Neurological Optimality Score (NOS) and the prevalence of the clinically relevant complex MND. Neurological condition of the three subfertile groups did not differ significantly: median NOS was 53 in each subfertile group and the prevalence of complex MND in the three subfertile groups was 30%, 37% and 36%, respectively. However, the NOS was lower and the prevalence of complex MND higher in children born to subfertile couples than in children of fertile couples (adjusted mean difference [95% CI]: -4.48 [-5.53 to -3.42]) and adjusted OR [95% CI]: 5.13 [2.60-10.16], respectively). We conclude that ovarian hyperstimulation, in vitro procedures, and the combination of both were not associated with a less favourable neurological outcome of 9-year-old singletons. However, the presence of parental subfertility was associated with less favourable neurological outcome of offspring at 9 years follow up. [ABSTRACT FROM AUTHOR]

Background: Development of postural problems in Cerebral Palsy (CP) is largely unknown. Postural muscle activity is organized into two levels: 1) direction-specificity; 2) fine-tuning of direction-specific activity.Aim: To study development of postural control until 21 months corrected age in subgroups of infants at very high-risk (VHR) of CP: a) with and without CP at 21 months; b) with and without cystic periventricular leukomalacia (cPVL), the brain lesion with highest risk of CP.Methods and Procedures: Longitudinal electromyography recordings of postural muscles during reaching were made in 38 VHR-infants (severe brain lesion or clear neurological signs) between 4.7 and 22.6 months (18 CP, of which 8 with cPVL). Developmental trajectories were calculated using linear mixed effect models.Outcomes and Results: VHR-infants with and without CP showed virtually similar postural development throughout infancy. The subgroup of VHR-infants with cPVL improved performance in direction-specificity with increasing age, while they performed throughout infancy worse in fine-tuning of postural adjustments than infants without cPVL.Conclusions and Implications: VHR-infants with and without CP have a similar postural development that differs from published trajectories of typically developing infants. Infants with cPVL present from early age onwards dysfunctions in fine-tuning of postural adjustments; they focus on direction-specificity. [ABSTRACT FROM AUTHOR]

Background: Early identification of infants at risk of cerebral palsy (CP) is desirable in order to provide early intervention. We previously demonstrated differences in knee jerk responses between 3-month-old high risk and typically developing infants.Aims: To improve early identification by investigating whether the presence of tonic responses (continuous muscle activity occurring after the typical phasic response), clonus or contralateral responses to the knee jerk during infancy is associated with CP.Study Design: Longitudinal EMG-study.Subjects: We included 34 high-risk infants (median gestational age 31.9 weeks) who participated in the LEARN2MOVE 0-2 years trial.Outcome Measures: Video-recorded knee jerk EMG-assessments were performed during infancy (1-4 times). Developmental outcome was assessed at 21 months corrected age (CA). Binomial generalized estimating equations models with repeated measurements were fitted using predictor variables.Results: Infants who later were diagnosed with CP (n = 18) showed more often than infants who were not diagnosed with CP i) tonic responses - from 4 months CA onwards, ii) clonus - from 13 months CA onwards, and iii) contralateral responses - from 15 months CA onwards.Limitations: The main limitation is the relatively small sample size.Conclusions: The assessment of tonic responses to the knee jerk using EMG may be a valuable add-on tool to appraise a high risk of CP. [ABSTRACT FROM AUTHOR]

Background: In typical development, postural adjustments during reaching change in the second half of infancy, including increasing rates of direction-specific adjustments. These changes are absent or different in infants at risk of cerebral palsy (CP). To discover whether these changes are related to acquisition of independent walking, we studied postural adjustments during reaching in infants before and after they learned to walk.Methods: Ten typically developing (TD) infants and 11 infants at very high risk (VHR) of CP were assessed before and after they learned to walk. Reaching movements were elicited during supported sitting, while surface electromyography was recorded of arm, neck, and trunk muscles. Percentages of direction-specific adjustments (first level of control), and recruitment patterns and anticipatory activation (second level of control) were calculated.Results: In both groups, postural adjustments during reaching were similar before and after acquisition of independent walking. Direction-specificity increased with age in typically developing infants but not in VHR-infants.Conclusion: Increasing age rather than the transition to independent walking is associated with increasing direction-specificity of TD-infants during reaching while sitting, while infants at very high risk of CP show no increase in direction-specificity, suggesting that they gradually grow into a postural deficit. [ABSTRACT FROM AUTHOR]

Background: The effect of forward-tilting of the seat surface and foot-support in children with spastic cerebral palsy (CP) is debated.Aim: To assess the effect of forward-tilting of the seat surface and foot-support in children with CP on kinematic head stability and reaching.Methods: Nineteen children functioning at Gross Motor Function Classification System levels I-III participated [range 6-12y; ten unilateral spastic CP (US-CP) and nine bilateral spastic CP (BS-CP)]. Kinematic data were recorded of head sway and reaching with the dominant arm in four sitting conditions: a horizontal and a 15° forward (FW) tilted seat surface, each with and without foot-support.Results: Seating condition did not affect head stability during reaching, but did affect kinematic reaching quality. The major reaching parameters, i.e., the proportion of reaches with one movement unit (MU) and the size of the transport MU, were not affected by foot-support. Forward-tilting had a positive effect on these parameters in children with US-CP, whereas the horizontal condition had this effect in children with BS-CP.Implications: A 15° forward-tilted seating and foot-support do not affect head stability. Reaching in children with US-CP profits from forward-tilting; in children with BS-CP forward-tilting worsens reaching - effects that are independent of foot-support. [ABSTRACT FROM AUTHOR]

Aim: To investigate associations between neurological condition, assessed with the Hempel examination, in terms of minor neurological dysfunction (MND) and neurological optimality, and cognition and behaviour at 4years.Study Design: Cross-sectional analyses within a prospective, assessor-blinded follow-up study.Subjects: Four-year-old singletons born to subfertile parents (n=235; 120 boys).Outcome Measures: Outcome parameters were complex minor neurological dysfunction (complex MND) and the neurological optimality score (NOS). Cognitive outcome was evaluated with the Kaufman Assessment Battery for Children, resulting in a total intelligence quotient (IQ). Behavioural outcome was evaluated with the Child Behavior Checklist, resulting in a total problem T-score.Results: Fifty-seven (24.3%) children had complex MND. None of the children showed fine motor dysfunction, suggesting a ceiling effect of the Hempel assessment. Complex MND was not correlated with IQ or total problem T-score. Nevertheless, a higher NOS was correlated with a higher IQ and a lower total problem T-score (adjusted mean estimate [95% confidence interval]: cognition: 0.445 [0.026; 0.865], p=0.038; behaviour: -0.458 [-0.830; -0.087], p=0.016).Interpretation: At age 4, complex MND assessed with the Hempel assessment was not associated with cognition and behaviour, presumably due to a ceiling effect in the Hempel domain of fine motor function. A more optimal neurological condition was associated with higher IQ and better behaviour. [ABSTRACT FROM AUTHOR]

This prospective cohort study evaluated whether the cognitive development, neurological condition, anthropometrics and blood pressure of 4-year-old IVF twins differed from those of 4-year-old IVF singletons; 103 IVF singletons and 48 IVF twins born after conventional IVF treatment were included. Primary outcome was total intelligence quotient (IQ). Secondary outcomes were minor neurological dysfunction, anthropometrics and blood pressure. Unadjusted analyses found that the total IQ score of twins was lower than that of singletons, with a mean difference of −5.4 (–9.7 to −1.0). Weight (singletons: 18.6 [18.1 to 19.1] kg; twins: 16.9 [16.0 to 17.9] kg) and height (singletons: 108.8 [107.9 to 109.8] cm; twins: 105.9 [104.0 to 107.7] cm) of twins were lower than those of singletons (mean values [95% CI]). All differences disappeared after adjusting for mediators and confounders. Neurological outcome, systolic and diastolic blood pressure of twins and singletons were similar. Four-year-old IVF twins had a lower total IQ (−5.4 points), lowerbodyweight (−1.7 kg) and were shorter (−2.9 cm) than 4-year-old IVF singletons. After adjustment, the adverse twin effect disappeared, implying that increased risk for impaired health and development in twins also holds true for IVF twins, and is not altered by IVF. [ABSTRACT FROM AUTHOR]

Background: The long-term effect of early intervention in infants at risk for developmental disorders is unclear. The VIP project (n=46, originally) evaluated by means of a randomised controlled trial the effect of the family centred early intervention programme COPCA (Coping with and Caring for infants with special needs) in comparison to that of traditional infant physiotherapy (TIP).Aims: To evaluate the effect of early intervention on functional outcome at school age.Methods and Procedures: Parents of 40 children (median age 8.3years) participated in this follow-up study. Outcome was assessed with a standardised parental interview (Vineland Adaptive Behaviour Scale) and questionnaires (Developmental Coordination Disorder Questionnaire, Child Behaviour Checklist, Utrechtse Coping List, and questions on educational approach). Quantified video information on physiotherapeutic actions during infancy was available.Outcomes and Results: Child functional outcome in the two randomised groups was similar. Process evaluation revealed that some physiotherapeutic actions were associated with child mobility and parental educational approach at follow-up: e.g., training and instructing were associated with worse mobility.Conclusions and Implications: Functional outcome at school age after early intervention with COPCA is similar to that after TIP. However, some specific physiotherapeutic actions, in particular the physiotherapist's approach, are associated with outcome.What This Paper Adds: Early intervention is generally applied in infants at risk for developing disorders, with the aim of improving overall functional outcome. However, little is known on the long-term effect. The VIP project evaluated by means of a randomised controlled trial the effect of the family centred early intervention programme COPCA (Coping with and Caring for infants with special needs) in comparison to that of traditional infant physical therapy (TIP). Outcome at 18months corrected age was virtually similar. Process evaluation of the physiotherapy actions revealed that some characteristics of COPCA were associated with improved developmental outcome at 18months. This paper presents data on functional outcome at school age (median 8.3years) in 87% of the original participants. Outcome of infants who received three months of COPCA and that of infants who received three months of TIP was similar. Yet, parents of families who had received the COPCA intervention still more often used a trial and error approach when the child learned a new skill than parents of children who had received TIP. Process evaluation showed that more time spent on caregiver training and strict instructions during early intervention was associated with worse mobility. Four other physiotherapeutic actions were associated with parental educational approach. None of the neuromotor actions were associated with child outcome at school age. We conclude that long-term outcome after three months of COPCA or TIP is similar. However, our study does suggest that the professional approach of the physiotherapist can make a difference. [ABSTRACT FROM AUTHOR]

Background: General movements (GM) are used in academic settings to predict developmental outcome in infants born preterm. However, little is known about the implementation and predictive value of GM in non-academic settings.Aims: The aim of this study is twofold: To document the implementation of GM assessment (GMA) in a non-academic setting and to assess its predictive value in infants born preterm.Methods and Procedures: We documented the process of implementing GMA in a non-academic outpatient clinic. In addition, we assessed the predictive value of GMA at 1 and 3 months' corrected age for motor and cognitive development at 2 years in 122 children born <33 weeks' gestation. Outcome at two years was based upon the Bayley Scales of Infant Development-II (mental/psychomotor developmental index (MDI, PDI)) and a neurological examination. The infants' odds of atypical outcome (MDI or PDI ≤70 or diagnosis CP) and the predictive accuracy of abnormal GMA were calculated in a clinical routine scenario, which used all available GM information (primarily at 3 months or at 1 month, when 3 months were not available). In addition, separate analysis was undertaken for the samples of GMA at 1 and 3 months.Outcomes and Results: Tips to facilitate GMA implementation are described. In our clinical routine scenario, children with definitely abnormal GM were more likely to have an atypical two-year outcome than children with normal GM (OR 13.2 (95% CI 1.56; 112.5); sensitivity 55.6%, specificity 82.1%). Definitely abnormal GM were associated with reduced MDI (-12.0, 95% CI -23.2; -0.87) and identified all children with cerebral palsy (CP) in the sample of GMA at 3 months only.Conclusions and Implications: GMA can be successfully implemented in a non-academic outpatient setting. In our clinical routine scenario, GMA allowed for adequate prediction of neurodevelopment in infants born preterm, thereby allaying concerns about diagnostic accuracy in non-academic settings. [ABSTRACT FROM AUTHOR]

Research on cognitive and behavioural development of children born after assisted conception is inconsistent. This prospective study aimed to explore underlying causal relationships between ovarian stimulation, in-vitro procedures, subfertility components and child cognition and behaviour. Participants were singletons born to subfertile couples after ovarian stimulation IVF ( n = 63), modified natural cycle IVF ( n = 53), natural conception ( n = 79) and singletons born to fertile couples (reference group) ( n = 98). At 4 years, cognition (Kaufmann-ABC-II; total IQ) and behaviour (Child Behavior Checklist; total problem T-score) were assessed. Causal inference search algorithms and structural equation modelling was applied to unravel causal mechanisms. Most children had typical cognitive and behavioural scores. No underlying causal effect was found between ovarian stimulation and the in-vitro procedure and outcome. Direct negative causal effects were found between severity of subfertility (time to pregnancy) and cognition and presence of subfertility and behaviour. Maternal age and maternal education acted as confounders. The study concludes that no causal effects were found between ovarian stimulation or in-vitro procedures and cognition and behaviour in childrenaged 4 years born to subfertile couples. Subfertility, especially severe subfertility, however, was associated with worse cognition and behaviour. [ABSTRACT FROM AUTHOR]

Background: Long chain polyunsaturated fatty acid (LCPUFA) status is associated with risk of cardiovascular diseases in adulthood. We previously demonstrated no effect of LCPUFA supplementation after birth on BP and anthropometrics. Little is known about the association between fatty acid status at birth and cardiometabolic health at older ages.Aim: To evaluate associations between docosahexaenoic acid (DHA) and arachidonic acid (AA) levels in the umbilical cord and blood pressure (BP) and anthropometrics at 9years.Study Design: Observational follow-up study. Multivariable analyses were carried out to adjust for potential confounders.Subjects: 229 children who took part in a randomized controlled trial (RCT) on the effects of LCPUFA formula supplementation.Outcome Measures: BP was chosen as primary outcome; heart rate and anthropometrics as secondary outcomes.Results: AA levels in the wall of the umbilical vein and artery were negatively associated with diastolic BP (B: vein -0.831, 95% CI: -1.578; -0.083, p=0.030; artery: -0.605, 95% CI: -1.200; -0.010, p=0.046). AA was not associated with systolic BP; DHA not with diastolic nor systolic BP. The AA:DHA ratio in the umbilical vein was negatively associated with diastolic BP (B: -1.738, 95% CI: -3.141; -0.335, p=0.015). Heart rate and anthropometrics were not associated with neonatal LCPUFA status.Conclusions: Higher AA levels and a higher AA:DHA ratio at birth are associated with lower diastolic BP at age 9. This suggests that the effect of LCPUFAs at early age is different from that in adults, where DHA is regarded anti-adipogenic and AA as adipogenic. [ABSTRACT FROM AUTHOR]

Background: Paediatric physiotherapy (PPT) in high-risk infants comprises family involvement, but it is unclear whether parents mediate the intervention effect. We demonstrated in a randomized controlled trial in high-risk infants comparing the family centred programme Coping and Caring for infants with special needs (COPCA) and Traditional Infant Physiotherapy (TIP) that process evaluation revealed associations between COPCA-characteristics and outcome.Aims: To assess whether PPT affects how parents position their infant during bathing and whether this is associated with child outcome.Methods and Procedures: 21 infants received COPCA and 25 TIP between 3 and 6 months corrected age. Bathing sessions were videotaped at 3, 6 and 18 months. Time spent with specific infant positions was correlated with quantified PPT-actions and functional mobility at 18 months measured with the Paediatric Evaluation of Disability Inventory (PEDI).Outcomes and Results: At 3 and 18 months bathing position was similar in both groups, but differed at 6 months (time spent on sitting: COPCA 77.7%, TIP 39.2%; median difference 32.0% (95% CI: 10.6-50.5%). Sitting-time at 6 months was associated with higher PEDI functional mobility scores.Conclusions and Implications: Early PPT may affect parental behaviour, such as infant positioning during bathing, which, in turn, may affect child development. [ABSTRACT FROM AUTHOR]

Background: General movement (GM) assessment is a well-established tool to predict cerebral palsy in high-risk infants. Little is known on the predictive value of GM assessment in low-risk populations.Aims: To assess the predictive value of GM quality in early infancy for the development of the clinically relevant form of minor neurological dysfunction (complex MND) and behavioral problems at preschool age.Study Design: Prospective cohort study.Subjects: A total of 216 members of the prospective Groningen Assisted Reproductive Techniques (ART) cohort study were included in this study. ART did not affect neurodevelopmental outcome of these relatively low-risk infants born to subfertile parents.Outcome Measures: GM quality was determined at 2 weeks and 3 months. At 18 months and 4 years, the Hempel neurological examination was used to assess MND. At 4 years, parents completed the Child Behavior Checklist; this resulted in the total problem score (TPS), internalizing problem score (IPS), and externalizing problem score (EPS). Predictive values of definitely (DA) and mildly (MA) abnormal GMs were calculated.Results: DA GMs at 2 weeks were associated with complex MND at 18 months and atypical TPS and IPS at 4 years (all p<0.05). Sensitivity and positive predictive value of DA GMs at 2 weeks were rather low (13%-60%); specificity and negative predictive value were excellent (92%-99%). DA GMs at 3 months occurred too infrequently to calculate prediction. MA GMs were not associated with outcome.Conclusions: GM quality as a single predictor for complex MND and behavioral problems at preschool age has limited clinical value in children at low risk for developmental disorders. [ABSTRACT FROM AUTHOR]

This study evaluated the prevalence of asthma and asthma medication use in 213 4-year-old singletons followed from birth onwards, including three groups of children born following: (i) controlled ovarian hyperstimulation IVF/intracytoplasmic sperm injection (ICSI); (ii) modified natural cycle IVF/ICSI; and (iii) natural conception in subfertile couples. The rate of asthma medication was higher in the ovarian hyperstimulation-IVF/ICSI than in the subfertile group (adjusted odds ratios [aOR]: 1.96 [1.00–3.84]). Time to pregnancy, a proxy for the severity of subfertility, was not associated with asthma and asthma medication. In conclusion, controlled ovarian hyperstimulation-IVF/ICSI is associated with the use of asthma medication in 4-year-old offspring of subfertile couples. [ABSTRACT FROM AUTHOR]

Background: Long-chain polyunsaturated fatty acids (LCPUFA) are important for prenatal brain development. Previous studies of others assessed outcome until 7 years. The associations between neonatal LCPUFA status and long-term developmental outcome are debated.Aim: To investigate the relationship between fatty acid status at birth and neurodevelopment at 9 years. Age 9 is a unique age after a significant neurodevelopmental transition.Study Design: Correlation study. Multivariable analyses were carried out to adjust for potential confounders.Subjects: 317 children who participated in a trial on effects of postnatal LCPUFA supplementation were eligible. 235 children (74%) were reassessed at age 9.Outcome Measures: At birth, docosahexaenoic acid (DHA) and arachidonic acid (AA) were determined in the wall of the umbilical vein. We primarily studied the correlation between DHA and AA with the complex form of minor neurological dysfunction (cMND). Secondary correlations that were studied were DHA and AA levels with cognitive development in terms of full IQ, and with behavioural development in terms of a total problem score.Results: Boys with cMND showed lower DHA values in the umbilical vein than children with better neurological condition (p=0.033). A similar association was absent in girls. Neonatal AA values were not associated with neurological outcome. Neither neonatal DHA nor AA values were associated with cognition and behaviour at 9.Conclusions: Higher umbilical DHA levels in boys are associated with better neurological development at 9 years. AA status at birth was not associated with neurodevelopment at 9 years. [ABSTRACT FROM AUTHOR]

Background: The Infant Motor Profile (IMP) is an appropriate tool to assess and monitor infant motor behaviour over time. Infants at very high risk (VHR) due to a lesion of the brain generally show impaired motor development. They may grow into or out of their neurodevelopmental deficit.Aims: Evaluate associations between IMP-trajectories, summarised by IMP-scores in early infancy and rates of change, and functional and cognitive outcome at school-age in VHR-children.Study Design: Longitudinal study.Subjects: 31 VHR-children, mainly due to a brain lesion, who had multiple IMP-assessments during infancy, were re-assessed at 7-10 years (school-age).Outcome Measures: Functional outcome was assessed with the Vineland-II, cognition with RAKIT 2. Associations between IMP-trajectories and outcome were tested by multivariable linear regression analyses.Results: When corrected for sex, maternal education and follow-up age, initial scores of total IMP, variation and performance domains, as well as their rates of change were associated with better functional outcome (unstandardised coefficients [95% CI]): 36.44 [19.60-53.28], 33.46 [17.43-49.49], 16.52 [7.58-25.46], and 513.15 [262.51-763.79], 356.70 [148.24-565.15], and 269 [130.57-407.43], respectively. Positive rates of change in variation scores were associated with better cognition at school-age: 34.81 [16.58-53.03].Conclusion: Our study indicated that in VHR-children IMP-trajectories were associated with functional outcome at school-age, and to a minor extent also with cognition. Initial IMP-scores presumably reflect the effect of an early brain lesion on brain functioning, whereas IMP rate of change reflects whether infants are able to grow into or out of their initial neurodevelopmental deficit. [ABSTRACT FROM AUTHOR]