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Previous studies have shown that the mean dose to the parotid gland stem cell rich regions (D mean,SCR) is the strongest dosimetric predictor for the risk of patient-reported daytime xerostomia. This study aimed to test whether the relationship between patient-reported xerostomia and D mean,SCR is explained by a dose-dependent reduction of saliva production. In 570 patients with head and neck cancer treated with definitive radiation therapy (RT), flow from the parotid (FLOW PAR) and submandibular/sublingual (FLOW SMSL) glands, and patient-reported daytime (XER DAY) and nighttime (XER NIGHT) xerostomia were prospectively measured before, at 6 months, and 12 months after RT. Using linear mixed effect models, the relationship of the mean dose to the parotid glands (D mean,par), D mean,SCR , non-SCR parotid gland tissue (D mean,non-SCR), submandibular glands (D mean,sub), and oral cavity (D mean,oral) with salivary flow and xerostomia was analyzed while correcting for known confounders. D mean,SCR proved to be responsible for the effect of D mean,par on FLOW PAR (P ≤.03), while D mean,non-SCR did not affect FLOW PAR (P ≥.11). To illustrate, increasing D mean,SCR by 10 Gy at a fixed D mean,non-SCR reduced FLOW PAR by 0.02 mL/min (25%) after RT. However, if the opposite happened, no change in FLOW PAR was observed (0.00 mL/min [4%]). As expected, D mean,sub was significantly associated with FLOW SMSL (P <.001). For example, increasing D mean,sub by 10 Gy reduced FLOW SMSL by 0.07 mL/min (26%) after RT. Xerostomia scores were also affected by dose to the salivary glands. D mean,SCR and D mean,oral were associated with higher XER DAY scores (P ≤.05), while D mean,sub increased XER NIGHT scores (P =.01). For example, an increase of 10 Gy in D mean,SCR raised XER DAY scores by 2.13 points (5%) after RT, while an additional 10 Gy in D mean,subs increased XER NIGHT scores by 2.20 points (6%) after RT. Salivary flow was not only associated with radiation dose, but also with xerostomia scores in line with the salivary glands' functions; ie, FLOW PAR only influenced XER DAY (P <.001, 10.92 points lower XER DAY per 1 mL/min saliva), while FLOW SMSL affected XER DAY and XER NIGHT (P ≤.004, 6.69 and 5.74 points lower XER DAY and XER NIGHT , respectively, per 1 mL/min saliva). Therefore, the observed relationships between dose and xerostomia were corrected for salivary flow. As hypothesized, D mean,SCR only increased XER DAY scores via reducing FLOW PAR , whereas the effects of D mean,oral on XER DAY and D mean,sub on XER NIGHT were independent of salivary flow. Higher SCR region dose reduced parotid gland saliva production, subsequently resulting in higher daytime xerostomia scores. Consequently, this study supports the clinical implementation of stem cell sparing RT to preserve salivary flow with the aim of reducing the risk of xerostomia. [ABSTRACT FROM AUTHOR]

Aim: The Infant Motor Profile (IMP) is a qualitative assessment of motor behaviour of infants aged 3 to 18 months. The aim of this study was to investigate construct validity of the IMP through the relation of IMP scores with prenatal, perinatal, and neonatal variables, including the presence of brain pathology indicated by neonatal ultrasound imaging of the brain. Method: A longitudinal prospective study was performed in a group of 30 term infants (12 females, 18 males; median gestational age 40.1wks, range 37.6-42wks) and 59 preterm infants (25 females, 34 males; median gestational age 29.7wks, range 25-34.7wks). IMP assessments were performed at (corrected) ages of 4, 6, 10, 12, and 18 months. Socio-economic and perinatal data were collected, which, in the case of preterm infants, included information on periventricular leukomalacia and intraventricular hemorrhage based on neonatal cranial ultrasound. Data were analysed by fitting mixed-effects models. Results: Gestational age, socio-economic status, and 5-minute Apgar scores were significant determinants of IMP scores in the total group of infants (p less than 0.001, less than 0.002, and less than 0.042 respectively). In the subgroup of preterm infants, IMP scores were significantly affected by brain lesions on neonatal ultrasound (p less than 0.001) and by socio-economic status (p = 0.001). Interpretation: The findings support the construct validity of the IMP: IMP scores are clearly associated with relevant determinants of neuromotor function.

Aim: To evaluate whether infants with complex congenital heart disease (CCHD) have an increased risk of impaired quality of motor behavior and delayed motor milestones. Method: A cohort of 69 infants with CCHD (43 males, 26 females) were assessed with the Infant Motor Profile (IMP) at three time periods between 6 to 18 months, mean ages in months (SD): 6.4 (0.7); 12.7 (1.0); 18.5 (0.7) IMP data were available from a reference sample of 300 Dutch infants. Analyses included multivariable logistic regression analysis to estimate differences in IMP scores below the 15th centile between children with CCHD and the reference group, and linear mixed‐effects models to assess the effect of ventricular physiology and systemic oxygen saturation (SpO2) of less than 90% on IMP outcomes. Results: Infants with CCHD had increased risks of total IMP scores below the 15th centile (lowest odds ratio [OR] at 18mo: 6.82 [95% confidence interval {CI} 2.87–16.19]), especially because of lower scores in the domains of variation, adaptability, and performance. Children with single ventricle CCHD scored consistently 3.03% (95% CI 1.00–5.07) lower than those with two ventricle physiology, mainly from contributions of the variation and performance domains. SpO2 of less than 90% was associated with 2.52% (95% CI 0.49–4.54) lower IMP scores. Interpretation: CCHD, especially single ventricle physiology, increases risk of impaired motor development. What this paper adds: Complex congenital heart disease (CCHD) substantially increases risk of impaired motor development.CCHD is associated with motor delay and reduced motor variation and adaptability.Single ventricle physiology increases the risk of impaired motor behavior. [ABSTRACT FROM AUTHOR]