Comparison of Griffiths-II and Bayley-II tests for the developmental assessment of high-risk infants.

INTRODUCTION: Two important risk factors for abnormal neurodevelopment are preterm birth and neonatal hypoxic ischemic encephalopathy. The new revisions of Griffiths Mental Development Scale (Griffiths-II, [1996]) and the Bayley Scales of Infant Development (BSID-II, [1993]) are two of the most frequently used developmental diagnostics tests. The Griffiths-II is divided into five subscales and a global development quotient (QD), and the BSID-II is divided into two scales, the Mental scale (MDI) and the Psychomotor scale (PDI). The main objective of this research was to establish the extent to which developmental diagnoses obtained using the new revisions of these two tests are comparable for a given child. MATERIAL AND METHODS: Retrospective study of 18-months-old high-risk children examined with both tests in the follow-up Unit of the Clinic of Neonatology of our tertiary care university Hospital between 2011 and 2012. To determine the concurrent validity of the two tests paired t-tests and Pearson product-moment correlation coefficients were computed. Using the BSID-II as a gold standard, the performance of the Griffiths-II was analyzed with receiver operating curves. RESULTS: 61 patients (80.3% preterm, 14.7% neonatal asphyxia) were examined. For the BSID-II the MDI mean was 96.21 (range 67-133) and the PDI mean was 87.72 (range 49-114). For the Griffiths-II, the QD mean was 96.95 (range 60-124), the locomotors subscale mean was 92.57 (range 49-119). The score of the Griffiths locomotors subscale was significantly higher than the PDI (p<0.001). Between the Griffiths-II QD and the BSID-II MDI no significant difference was found, and the area under the curve was 0.93, showing good validity. All correlations were high and significant with a Pearson product-moment correlation coefficient >0.8. CONCLUSIONS: The meaning of the results for a given child was the same for the two tests. Two scores were interchangeable, the Griffiths-II QD and the BSID-II MDI.

Influence of intrauterine and extrauterine growth on neurodevelopmental outcome of monozygotic twins

There have been indications that intrauterine and early extrauterine growth can influence childhood mental and motor function. The objective of the present study was to evaluate the influence of intrauterine growth restriction and early extrauterine head growth on the neurodevelopmental outcome of monozygotic twins. Thirty-six monozygous twin pairs were evaluated at the corrected age of 12 to 42 months. Intrauterine growth restriction was quantified using the fetal growth ratio. The effects of birth weight ratio, head circumference at birth and current head circumference on mental and motor outcomes were estimated using mixed-effect linear regression models. Separate estimates of the between (interpair) and within (intrapair) effects of each measure on development were thus obtained. Neurodevelopment was assessed with the Bayley Scales of Infant Development, 2nd edition, by a psychologist blind to the exposure. A standardized neurological examination was performed by a neuropediatrician who was unaware of the exposures under investigation. After adjustment, birth weight ratio and head circumference at birth were not associated with motor or mental outcomes. Current head circumference was associated with mental but not with motor outcomes. Only the intrapair twin effect was significant. An increase of 1 cm in current head circumference of one twin compared with the other was associated with 3.2 points higher in Mental Developmental Index (95%CI = 1.06-5.32; P < 0.03). Thus, no effect of intrauterine growth was found on cognition and only postnatal head growth was associated with cognition. This effect was not shared by the co-twin.

Identification précoce des nouveau-nés qui auront des problèmes de développement à deux ans: utilité de l'Évaluation neurologique d'Amiel-Tison

Malgré les avancées médicales, la prédiction précoce du devenir développemental des enfants nés prématurément demeure un défi. Ces enfants sont à risque de séquelles plus ou moins sévères telles l'infirmité motrice d'origine cérébrale, les déficiences intellectuelles et sensorielles ainsi que les difficultés d'apprentissage. Afin de diminuer l’impact fonctionnel de ces séquelles, l’identification de marqueurs précoces devient un enjeu important. Dans le contexte actuel de ressources financières et humaines limitées, seuls les enfants nés avant 29 semaines de gestation ou avec un poids de naissance (PN) <1250g sont systématiquement suivis, laissant pour compte 95% des enfants prématurés. L’identification de marqueurs précoces permettrait de cibler les enfants nés après 28 semaines de gestation porteurs de séquelles. Le principal objectif des présents travaux visait à évaluer l’utilité de l’Évaluation neurologique d’Amiel-Tison (ENAT) dans l’identification et le suivi des enfants nés entre 29 et 37 semaines de gestation et qui présenteront des problèmes neurodéveloppementaux à l’âge corrigé (AC) de 24 mois. Plus précisément, la fidélité inter-examinateurs, la stabilité ainsi que la validité prédictive de l’ENAT ont été évaluées. La cohorte était composée initialement de 173 enfants nés entre 290/7 et 370/7 semaines de gestation, avec un PN<2500g et ayant passé au moins 24 heures à l’unité de soins néonatals du CHU Sainte-Justine. Les enfants étaient évalués avec l’ENAT à terme et aux AC de 4, 8, 12 et 24 mois. À l’AC de 24 mois, leur développement était évalué à l’aide du Bayley Scales of Infant Development–II. Les principaux résultats révèlent une excellente fidélité inter-examinateurs ainsi qu’une bonne stabilité au cours des deux premières années de vie du statut et des signes neurologiques. Des différences significatives à l’AC de deux ans ont été relevées aux performances développementales en fonction du statut neurologique à terme, qui constitue l’un des meilleurs facteurs prédictifs de ces performances. Les résultats encouragent l’intégration du statut neurologique tel que mesuré par l’ENAT comme marqueur précoce dans le cours d’une surveillance neurodéveloppementale des enfants les plus à risque.

Caractéristiques communautaires et issues de grossesse chez les Inuits du Québec

Les Inuits sont le plus petit groupe autochtone au Canada. Les femmes inuites présentent des risques beaucoup plus élevés d’issues de grossesse défavorables que leurs homologues non autochtones. Quelques études régionales font état d’une mortalité fœtale et infantile bien plus importante chez les Inuits canadiens par rapport aux populations non autochtones. Des facteurs de risque tant au niveau individuel que communautaire peuvent affecter les issues de grossesse inuites. Les relations entre les caractéristiques communautaires et les issues de grossesse inuites sont peu connues. La compréhension des effets des facteurs de risque au niveau communautaire peut être hautement importante pour le développement de programmes de promotion de la santé maternelle et infantile efficaces, destinés à améliorer les issues de grossesse dans les communautés inuites. Dans une étude de cohorte de naissance reposant sur les codes postaux et basée sur les fichiers jumelés des mortinaissances/naissances vivantes/mortalité infantile, pour toutes les naissances survenues au Québec de 1991 à 2000, nous avons évalué les effets des caractéristiques communautaires sur les issues de grossesse inuites. Lorsque cela est approprié et réalisable, des données sur les issues de grossesse d’un autre groupe autochtone majeur, les Premières Nations, sont aussi présentées. Nous avons tout d'abord évalué les disparités et les tendances temporelles dans les issues de grossesse et la mortalité infantile aux niveaux individuel et communautaire chez les Premières Nations et les Inuits par rapport à d'autres populations au Québec. Puis nous avons étudié les tendances temporelles dans les issues de grossesse pour les Inuits, les Premières Nations et les populations non autochtones dans les régions rurales et du nord du Québec. Les travaux concernant les différences entre milieu rural et urbain dans les issues de grossesse chez les peuples autochtones sont limités et contradictoires, c’est pourquoi nous avons examiné les issues de grossesse dans les groupes dont la langue maternelle des femmes est l’inuktitut, une langue les Premières Nations ou le français (langue majoritairement parlée au Québec), en fonction de la résidence rurale ou urbaine au Québec. Finalement, puisqu'il y avait un manque de données sur la sécurité des soins de maternité menés par des sages-femmes dans les communautés éloignées ou autochtones, nous avons examiné les issues de grossesse en fonction du principal type de fournisseur de soins au cours de l'accouchement dans deux groupes de communautés inuites éloignées. Nous avons trouvé d’importantes et persistantes disparités dans la mortalité fœtale et infantile parmi les Premières Nations et les Inuits comparativement à d'autres populations au Québec en se basant sur des évaluations au niveau individuel ou communautaire. Une hausse déconcertante de certains indicateurs de mortalité pour les naissances de femmes dont la langue maternelle est une langue des Premières Nations et l’inuktitut, et pour les femmes résidant dans des communautés peuplées principalement par des individus des Premières Nations et Inuits a été observée, ce qui contraste avec quelques améliorations pour les naissances de femmes dont la langue maternelle est une langue non autochtone et pour les femmes résidant dans des communautés principalement habitées par des personnes non autochtones en zone rurale ou dans le nord du Québec. La vie dans les régions urbaines n'est pas associée à de meilleures issues de grossesse pour les Inuits et les Premières Nations au Québec, malgré la couverture d'assurance maladie universelle. Les risques de mortalité périnatale étaient quelque peu, mais non significativement plus élevés dans les communautés de la Baie d'Hudson où les soins de maternité sont prodigués par des sages-femmes, en comparaison des communautés de la Baie d'Ungava où les soins de maternité sont dispensés par des médecins. Nos résultats sont peu concluants, bien que les résultats excluant les naissances extrêmement prématurées soient plus rassurants concernant la sécurité des soins de maternité dirigés par des sages-femmes dans les communautés autochtones éloignées. Nos résultats indiquent fortement le besoin d’améliorer les conditions socio-économiques, les soins périnataux et infantiles pour les Inuits et les peuples des Premières Nations, et ce quel que soit l’endroit où ils vivent (en zone éloignée au Nord, en milieu rural ou urbain). De nouvelles données de surveillance de routine sont nécessaires pour évaluer la sécurité et améliorer la qualité des soins de maternité fournis par les sages-femmes au Nunavik.

Incremento de la salud financiera mediante la utilización de la relación estratégica comunitaria y marketing.

Debido a las crisis mundiales, la perdurabilidad empresarial se ha convertido en la primera preocupación de las organizaciones, puesto que los problemas económicos en otros países pueden generar un efecto negativo en las condiciones del mercado doméstico, que junto con el entorno empresarial complejo y dinámico en el que se deben desempeñar las empresas hoy en día gracias a la globalización, sumado al aumento en la competitividad nacional e internacional, la perdurabilidad de las empresas se está viendo seriamente comprometida. Lo anterior, ha llevado a las empresas a buscar nuevas formas de mejorar su salud financiera. Para medir la salud financiera empresarial, se pueden usar distintos indicadores como lo es el flujo de caja que está asociado con la rentabilidad, el patrimonio que está asociado a las dificultades financieras, entre otros, o a través de varios modelos de bancarrota, los cuales, por medio de un conjunto de ratios financieros, reflejan el estado actual de la organización y su probabilidad de fracaso en el futuro. Las estrategias comunitarias y el marketing permiten incrementar la salud financiera de las empresas a través de la orientación al cliente y el establecimiento de relaciones gana-gana a largo plazo con las diferentes comunidades con las que se relaciona la organización.

A longitudinal study of perceptual grouping by proximity, luminance and shape in infants at two, four and six months

Grouping by luminance and shape similarity has previously been demonstrated in neonates and at 4 months, respectively. By contrast, grouping by proximity has hitherto not been investigated in infancy. This is also the first study to chart the developmental emergence of perceptual grouping longitudinally. Sixty-one infants were presented with a matrix of local stimuli grouped horizontally or vertically by luminance, shape or proximity at 2, 4, and 6 months. Infants were exposed to each set of stimuli for three presentation durations. Grouping was demonstrated for luminance similarity at the earliest testing age, 2 months, by shape similarity at 4 months, but was not observed for grouping by proximity. Grouping by shape similarity showed a distinctive pattern of grouping ability across exposure durations, which reflected familiarity preferences followed by novelty preferences. This remained stable across age. No link was found between the emergence of perceptual grouping ability and the exposure duration required to elicit grouping. We conclude by stressing the importance of longitudinal studies of infant development in furthering our understanding of human cognition, rather than relying on assumptions from the adult endstate.

Microbes central to human reproduction

As studies uncover the breadth of microbes associated with human life, opportunities will emerge to manipulate and augment their functions in ways that improve health and longevity. From involvement in the complexities of reproduction and fetal/infant development, to delaying the onset of disease, and indeed countering many maladies, microbes offer hope for human well-being. Evidence is emerging to suggest that microbes may play a beneficial role in body sites traditionally viewed as being sterile. Although further evidence is required, we propose that much of medical dogma is about to change significantly through recognition and understanding of these hitherto unrecognized microbe–host interactions. A meeting of the International Scientific Association for Probiotics and Prebiotics held in Aberdeen, Scotland (June 2014), presented new views and challenged established concepts on the role of microbes in reproduction and health of the mother and infant. This article summarizes some of the main aspects of these discussions.

Divisão de poder e autoridade civil: governança, políticas públicas e desenvolvimento local em projetos fomentados por agências multilaterais

Dentro do atual contexto de crescente urbanização e novas oportunidades econômicas, a relação entre economia local e governo emerge como uma área estratégica para a promoção do desenvolvimento. No presente contexto de consolidação democrática e reforma do Estado, a responsabilização está associada à capacidade dos cidadãos em atuar na definição de metas coletivas e na criação de mecanismos institucionais que garantam o controle público da ação governamental e seus líderes, incrementando a governabilidade e, se não a eficiência, a eficácia de políticas públicas e seus processos de gestão. Esse trabalho pretende contribuir para o entendimento do papel dos órgãos de financiamento multilaterais em projetos de DEL, nomeadamente, para compreensão e a avaliação desses programas quanto ao resgate e aperfeiçoamento de bases de legitimidade social em ações de governo vinculadas à processos de desenvolvimento e promoção democrática. De modo específico, esse trabalho ambiciona compreender a concepção de grupos de interesse e sociedade civil presentes nos contratos fomentados pelo banco, assim como, a relevância conferida à esses agentes pelos técnicos do banco por ocasião da formulação desses contratos. Ao investigar esses pontos a pesquisa objetiva contribuir para o debate acerca dos dilemas e desafios para a implementação de programas de desenvolvimento urbano promovidos por governos locais em conjunto com organismos multilaterais.

O conceito de nascimento na criança

O presente trabalho tem por objetivo primordial, examinar o desenvolvimento do conceito de nascimento em diferentes faixas etárias. A ideia de trabalhar sobre o tema surgiu da constatação de total carência de informação sobre o assunto não só no contexto brasileiro mas em geral, a partir de pesquisa empírica. Em termos teóricos, o problema é aqui abordado especialmente numa perspectiva psicodinâmica do desenvolvimento infantil. A tentativa de desenvolver a questão em termos cognitivos, como uma primeira aproximação, esbarrou nas contaminações culturais e socio-emocionais que o próprio tema contêm. É feito um estudo exploratório que confirma a hipótese formulada de que existe um desenvolvimento da referida noção em função da idade cronológica. Os resultados são discutidos em termos quantitativos e qualitativos, tentando-se explicar ao mesmo tempo a tomada de consciência do problema com o desenvolvimento cronológico e as distorções de que o tema se reveste em função dos aspectos emocionais envolvidos na questão proposta.

Detecção de alterações neuroendócrinas e comportamentais em bebês de mães com depressão pós-parto

Introdução: Há evidências consideráveis de uma grande influência da mãe e/ou do cuidador primário no desenvolvimento neurobiológico e psicológico da criança. Falhas no cuidado inicial devido a negligência, abuso físico e/ou psicológico estão associadas a alterações no desenvolvimento motor e mental, a depressão e ansiedade. A privação materna pode ocorrer no caso da depressão pós-parto (DPP) mesmo sem a intenção da mãe de prejudicar o bebê. Entre os achados na criança, associados à depressão da mãe, estão patologias do apego, alterações no EEG e no desenvolvimento mental e motor, déficit de aprendizado, sintomas de internalização e transtorno depressivo. Há uma associação entre cortisol salivar elevado na infância e história de depressão materna nos primeiros anos de vida. Objetivo: Examinar a correlação entre a depressão pós-parto e os níveis de cortisol salivar, bem como as alterações comportamentais e motoras, em bebês de seis meses, antes e após um estressor moderado, em comparação com um grupo controle. Método: Trinta e nove bebês de 6 meses (16 de mães deprimidas e 23 de mães controles) provenientes do ambulatório de puericultura e do serviço de neonatologia do Hospital de Clinicas de Porto Alegre (HCPA) participaram do estudo. As mães foram avaliadas através da mini entrevista neuropsiquiátrica internacional para adultos, semi-estruturada (MINI), segundo o DSM-IV. A gravidade da depressão foi avaliada através das escalas Escala de Depressão Pós-Parto de Edimburgo (EPDS) e do Inventário de BECK para depressão (BDI). Os bebês foram submetidos ao estressor denominado “Face-to-face stil-face”. Antes e após 10 min e 20 min deste procedimento foi coletado seu cortisol salivar. A dosagem do cortisol salivar foi feita por radioimunoensaio. A avaliação do desenvolvimento mental e motor através da Bayley Scales of Infant Development-II(BSID-II) As análises estatísticas foram feitas no programa SPSS for Windows, versão 12.0. Foram considerados significativos os resultados com p < 0,05. Resultados: Os níveis de cortisol salivar basal dos bebês de mães deprimidas estavam significativamente aumentados em comparação com o grupo controle. Foi verificada uma diferença estatisticamente significativa entre as médias das variações basal e 10 min nos bebês de mães deprimidas, quando comparada com os bebês de mães não deprimidas, controladas para valores basais. Observou-se uma correlação positiva moderada entre o cortisol basal do bebê e o BDI da mãe. Conclusão: Os achados deste estudo evidenciaram que os níveis de cortisol basal dos bebês de mães deprimidas estavam significativamente elevados em relação aos bebês de mães não deprimidas, assim como seus níveis de cortisol dez minutos após o estressor. O presente estudo sugere que aos 6 meses já pode estar ocorrendo uma alteração no eixo hipotálamo-pituitária-adrenal persistente e cronica. O achado de níveis basais aumentados é crucial devido as repercussões da elevação crônica dos glicocorticóides descrita na literatura. Este dado corrobora a hipótese de que intervenções precoces nas mães deprimidas devam ser realizadas visando também um trabalho preventivo em relação a prole.

Aspectos do cuidado cooperativo em dois grupos de Callithrix jacchus selvagens

The Callitrichidae family presents cooperative breeding, where breeders and non breeders take care of the offspring. The aspects of care analyzed in this study were infant carrying, supervision, proximity and food transfer. Three sets of infants from two wild groups of Callithrix jacchus were studied in the environments of Caatinga (Assu group) and Atlantic Forest (Jundiaí group). The methods used in the study were instantaneous focal sampling (infant carrying, supervision and proximity) and continuous focal sampling (food transfer). In the two sets observed in Assu group, the father carried and transferred food to infants more than the rest of the group. The biggest contribution in supervision was from the father and from another adult male. The members that remained in proximity to the infants in both groups were the younger in the groups (juveniles and sub-adults). In the Jundiaí group, the father and the adult male helper of the group were the main caregivers; one of the sub-adult females was responsible for supervision of the infants. With the disappearance of the reproductive male and one of the sub-adults females in 3º month of infants life, the care was redistributed and the only adult male left in the group was the animal that contributed more in provisioning of the infant. In the Assu group, there were adult females in its composition which were involved in agonistic interactions with breeders and adult males, and seemed to influence their low participation in care. Food transfer initiates early in the development of the infants, as a way to encourage nutritional independence. Different types of food transfer (active food transfer, food steal, food steal attempt, passive food transfer and food handling) were observed in the study and frequency of each one varied with developmental phase and tolerance by the members. One relevant data of the study was the presence of active food transfer in Assu group, since in literature there are very few registers of this type of transfer for this species. It is important that groups from distinct environments and composition be studied for a better understanding of the dynamics of infants development

The placenta as a barrier for toxic and essential elements in paired maternal and cord blood samples of South African delivering women

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Brazilian network for the surveillance of maternal potentially life threatening morbidity and maternal near-miss and a multidimensional evaluation of their long term consequences

Background. It has been suggested that the study of women who survive life-threatening complications related to pregnancy (maternal near-miss cases) may represent a practical alternative to surveillance of maternal morbidity/mortality since the number of cases is higher and the woman herself is able to provide information on the difficulties she faced and the long-term repercussions of the event. These repercussions, which may include sexual dysfunction, postpartum depression and posttraumatic stress disorder, may persist for prolonged periods of time, affecting women's quality of life and resulting in adverse effects to them and their babies. Objective. The aims of the present study are to create a nationwide network of scientific cooperation to carry out surveillance and estimate the frequency of maternal near-miss cases, to perform a multicenter investigation into the quality of care for women with severe complications of pregnancy, and to carry out a multidimensional evaluation of these women up to six months. Methods/Design. This project has two components: a multicenter, cross-sectional study to be implemented in 27 referral obstetric units in different geographical regions of Brazil, and a concurrent cohort study of multidimensional analysis. Over 12 months, investigators will perform prospective surveillance to identify all maternal complications. The population of the cross-sectional component will consist of all women surviving potentially life-threatening conditions (severe maternal complications) or life-threatening conditions (the maternal near miss criteria) and maternal deaths according to the new WHO definition and criteria. Data analysis will be performed in case subgroups according to the moment of occurrence and determining cause. Frequencies of near-miss and other severe maternal morbidity and the association between organ dysfunction and maternal death will be estimated. A proportion of cases identified in the cross-sectional study will comprise the cohort of women for the multidimensional analysis. Various aspects of the lives of women surviving severe maternal complications will be evaluated 3 and 6 months after the event and compared to a group of women who suffered no severe complications in pregnancy. Previously validated questionnaires will be used in the interviews to assess reproductive function, posttraumatic stress, functional capacity, quality of life, sexual function, postpartum depression and infant development. © 2009 Cecatti et al.