Poster group
Details of individual items:
poster
The Sheffield Birth Score (SBS), developed by Carpenter in England, is a weighted eight-factor screening instrument that was constructed to identify neonates who are at greater risk for death in the postperinatal period (8-364 days). Recently, the SBS has been utilized successfully in the United States to identify infants who are at greater risk for postneonatal mortality (PNM; 28-364 days). The current research is different from previous studies in that it investigated the risk of PNM for a group of infants whose siblings had also been scored through the SBS. Specifically, 3,505 women gave birth to single gestation infants in the index year (IY) 1992, and subsequently during 1993-95 (SY). Each IY birth was matched to the occurrence of a SY live birth, and all IY and SY infants were scored through the SBS. Eight variables were evaluated to determine theireffectiveness for predicting the SY infants' SBS general score, which is a measure of risk for PNM. The eight predictors included the IY infants' SBS risk status (High vs Low) for PNM, maternal education, interpregnancy interval length, marital status, adequacy of prenatal care, gestational age, tobacco usage, and alcohol usage. With the exception of the IY infants' SBS risk status score, the remaining seven predictors were directly linked to the histories (pregnancy,delivery) of the SY infants. All of the eight predictors significantly (p 0.0001 - 0.0033) entered into a multiple stepwise regression model, and the combined eight predictors accountedfor 35.7% of the variance in the SY infants' general SBS scores. The following is how the predictors respectively entered into the regression model and the amount of variance each predictor accounted for: IY infants' risk status for PNM (23.5%), maternal education (5.9%),interpregnancy interval length (3.3%), marital status (1.9%), adequacy of prenatal care (0.3%), gestational age (0.37%), tobacco usage (0.16%), and alcohol usage (0.25%). Mothers, whose IYinfants were at higher risk for PNM, were strikingly more likely to have SY infants who were also at greater risk for PNM. Maternal education, interpregnancy interval length, and marital status were modestly successful in accounting for portions of the variance in the SY infants' SBS risk for PNM. The seven variables that were directly linked to the SY infants' histories were less predictive of the SY infants' risk for PNM than was the birth of a sibling who was at higher risk for PNM. These findings appear to have salient implications for the delivery of health-care services, potential intervention programs, and for designing future research endeavors.
poster
Objective: Ultrasound is a safe and non-invasive method for early prenatal detection of fetal malformation. Several studies have dealt with the psychological implications of prenatal ultrasound diagnosis in pregnant women without any risk factors. But there are no empirical and prospective studies about the psychological effects of prenatal ultrasonographic diagnosis in pregnant women with a risk of fetal malformation. It is the main issue of this study to identify risk groups of pregnant women with maladaptive coping processes in respect to variance in levels of anxiety, personality, social factors and severity of fetal malformation. Method: In a longitudinal prospective study the anxiety levels (STAI, Spielberger et al., 1970) and coping processes (BEFO, Heim et al., 1991) of women (N3D674) during early pregnancy were assessed. Data were collected at three time points: immediately before the ultrasound scanning, at 5-6 weeks and at 10-12 weeks after the prenatal diagnosis for fetal malformation. Both questionnaires and semi-structured interviews were used to collect data. The control group of pregnant women had no risk-factors.Results: All women with high risk pregnancies (N3D506) showed high states of anxiety levels immediately before ultrasound scanning. Women with a diagnosed fetal malformation and those who upon endocrine screening were told there was a high probability of a positive diagnosis had the highest anxiety levels. There was a significant decrease in anxiety over the following 10-12 weeks. Only in the sub-group when malformation was confirmed anxiety remained high. In the no risk control group anxiety levels were not raised.One sub-group, with former loss of a pregnancy or prematurity, showed high or even increased anxiety levels over time, this is the case for the risk as well as the control group. Three coping factors could be extracted: one correlated with a reduction and one with an increase in anxiety. The third coping factor was not found to correlate with changes in the level of anxiety.Conclusion: Ultrasound scanning for fetal malformation can raise anxiety in pregnant women, especially when the diagnosis is confirmed. There are sub-groups with former trauma of pregnancy loss or prematurity who stay high in anxiety despite normal scanning. A combination of special coping strategies can reduce or increase anxiety. The results are used for psychotherapeutic intervention. References: Heim, E. et al. (1991). Berner Bew89ltigungsformen (BEFO). Handbuch. Bern: Huber.Spielberger, C.D. et al. (1970). Manual for the State-Trait Anxiety Inventory. Palo Alto, California: Consulting Psychologists Press.
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The aim of this study was to assess the anxietylevels, worry, experiences and feelings about herbaby of mothers on learning of the presence ofrenal dilatation or choroid plexus cysts in herfetus on her 19 week antenatal ultrasound scan.115 mothers were recruited at the 19 weekultrasound scan. Three groups of mothers werefollowed until the babies were 8 weeks old: 1)fetus with renal dilatation 2) fetus withisolated choroid plexus cyst 3) mothers withlow-lying placenta, as a comparison to the softmarker groups. Postal questionnaires were sentat 22 and 32 weeks antenatally and 4 and 8 weekspostnatally. Data included the SpielbergerState-Trait Anxiety Inventory, the Worry Scale,the Edinburgh Postnatal Depression Scale,ultrasonographer's reports of mother's anxietyduring the scan, adjective check-lists andmaternal reports of infant behaviour. Adescription of this study was presented at theICIS conference in 1996, but we shall be able topresent final results in 2000. All babies withrenal dilatation at the 19 week scan were giventrimethoprim at birth, and seven babies neededmedical follow-up. Mothers were not prepared forbad news at the 19 week scan, and received littlesupport or information about the condition seenon the scan. Some mothers felt that they hadbeen prevented from having a happy pregnancy.Further analysis will explore what the motherswere told, what experiences they had, and theirconcerns about their baby. How long theseconcerns linger are of interest. We shall alsoexplore the relationship between anxiety, worry,personality traits and maternal reactions.
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In efforts to promote earlier detection of developmental problems, the role of parents' appraisals has been considered in the literature (Kim, O'Connor, McLean, Robson & Chance, 1996). The Kent Infant Development (KID) Scale (Reuter & Bickett, 1985, Reuter & Reuter, 1990) is a caregiver completed record and possesses many of the attributes of a good developmental screening test (Savage & Neiman, 1996, Wozniak & Reuter, 1996). In our previous study on healthy fullterm infants (Prochazkova, Dittrichova, Brichacek, Sobotkova & Vondracek, 1997), the educational value of the KID Scale could be demonstrated: repeated parental appraisals of their infant behavior led the parents to a better understanding of their infant development. This may be important especially for parents of infants at developmental risk: parents' educational effort may increase if they are active participants in the assessment of the infant's developmental level.In this paper, the development of preterm infants in the first 14 months of age will be described by the use of the KID Scale.Twenty nine preterm infants (birth weight 1814.4 +/-472.2 g, gestational age 32.4 +/-2.5 weeks) were followed longitudinally from 1 to 14 months of age. The KID Scale contains 252 behavioural descriptions that are divided into five domains: cognitive, motor, language, self-help and social. The data were analysed using the computer scoring system (Kent Development Metrics 1995) and converted for the SOLO program. Thirty six control fullterm infants (birth weight 3429.2 +/-433.7, gestational age 39.5 +/-1.1 weeks) were used for comparison. At 3, 6, 9 and 12 months, all infants were examined by the Bayley Scales of Infant Development (Czech Edition 1983).Mean values of the KID full scale scores in preterm infants (corrected for prematurity) did not differed significantly from those of fullterm infants. However, some preterm infants scored repeatedly lower. This may indicate that the KID Scale assessment makes possible to screen early developmental delay.There were no significant differences between preterm and fullterm infants in the scores reached in individual domains (cognitive, motor, language, self-help, social).The raw scores obtained in individual domains intercorrelated in all months (1 - 14) in preterm as well as in fullterm infants. This may indicate that the items of all domains are highly internally consistent.There was a significant agreement between the KID Scale and the Bayley Scales assessments from the age of 6 months (motor development) and 9 months (mental development). The low agreement at 3 months may be due to differences of items included in both methods.Our results suggest that the KID Scale is a useful method for the assessment of early development in preterm infants.
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no abstract
poster
Lead exposure during infancy is known to cause cognitive impairment, butthe nature of the impairment is poorly understood. One hypothesis is thatlead damages prefrontal functioning, possibly through its effects onmidbrain dopamine cells. Experimental studies with nonhuman primates usingvarious reversal tasks has repeatedly shown inhibition and switchingdeficits, even at blood lead levels (BLLs) common in children today (Rice,1997). The present study examined the association between lead exposure duringinfancy and performance on a new executive function task, the 'ShapeSchool' (Espy, 1997). The Shape School is a storybook task for testinginhibition and switching processes. We examined these processes in acohort of 200 4-year-old children with BLLs measured at 6, 12, 18, 24, 36and 48 months (mean BLL7.9 ug/dL at 3 years). IQ deficits have beenpreviously documented in this cohort (Canfield et al., 1999). The two primary findings are that (1) BLLs at 3 and 4 years of age arebetter predictors of deficit than are BLLs during the first 18 months, and(2) deficits cannot be attributed to executive dysfunction. Children withhigher BLLs do not have poorer inhibitory control, they do not perseveratemore, and they do not show greater cognitive inflexibility. Instead, thedeficit appears to be associative in nature. This finding is consistentwith recent in-depth studies of reversal learning in lead-exposed rats(Hilson & Strupp, 1997). The present investigation provides no support for a lead-related prefrontaldeficit in children, at least at very low BLLs. The presence of anassociative impairment is consistent with findings of IQ deficits and theabsence of a clear 'behavioral signature' for low level lead exposure(Bellinger, 1995). Furthermore, slightly elevated BLLs during the first 18months of life appear to have no lasting effects on the particularcognitive functions we measured.
poster
The problem of perinatal hypoxia is very up-to-dateand it attracts physiologists and clinicists from thepoint of acceleration of the development of differentpathological states including sudden infant deathsyndrome (SIDS). In newborns, which undergoneperinatal hypoxia, one can see myocardial ischemia,accompanying by traumatical nervous system damage. Thecomparative analysis of clinical and experimental dataconcerning newborn hypoxia and it's delayedconsequences was performed in this study. Holter monitoring was held on 38 clinically healthy2-4-month-old infants, 18 - control subjects (1stgroup) and 20 subjects with hypoxia in anamnesis (2ndgroup). R-R interval assessment included MEAN value(ms); SDNN (ms); RMSSD (ms); pNN50 (%).Experimental part of the investigation was performedon 7- (n 210), 14- (n 344) and 21-days old (n 352)rat pups. Standard method of acute hypobaric hypoxiamodelling was used. Pose retention, lifetime,restitution time and simultaneous ECG recording weretested. Heptapeptide Semax (ACTH4-7PGP) was injected15 minutes before the hypoxic event.Statistically significant increase of all testedparameters in infants of 2nd group was shown. Allrevealed changes are the reflection of vagalinfluences on heart rate ratio in children undergoneperinatal hypoxia. In the experimental part of the research the agedifference in acute hypobaric hypoxia resistance andheart variability was shown. The occurrence ofcritical period of rat ontogenesis (14th postnatalday) and correlation between growth of SIDS incidenceand acute hypoxia resistance is suggested. Profilactic Semax injection significantly increasedacute hypobaric hypoxia resistance values and loweredheart rate variability. Heptapeptide effect wasobserved 20 days later.
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At-risk infants have increasingly become a focus of attention, partly, because they pose a special problem in terms of the provision of early intervention services. This problem involves the need for an efficient and effective means of identifying at-risk infants early. Despite the growing need and focus on serving infants, many children are not identified until school age, too late to receive the maximum benefits of intervention. Therefore, a fundamental issue remains in early identification and the provision of early intervention services for infants at-risk for disabilities. To address this paramount issue, one under-used, yet productive method, developmental epidemiology, can be applied (Cluett, Mulvihill, Wallander, & Hovinga, 1999; Scott, Shaw & Urbano, 1994). Applications of developmental epidemiological methods primarily include using linked birth and school records, combined with other data sets (e.g., WIC records). This study extends the use of developmental epidemiological data linkage to predict risk by linking multiple data sets including: birth records, infant and toddler service records, preschool service records, and school data. By completing this data linkage, in effect, a longitudinal developmental trajectory for each infant is created. This trajectory facilitates the examination of which early child and family risk factors or combinations of risk factors are predictive of poor developmental outcomes and at which stage of development the risk factors are impacting children the most. The present study includes children born or served via early intervention services (birth to five) or Department of Public Instruction in North Carolina during multiple years. Preliminary data linkage and analysis completed (linkage of infant/toddler data and school data only) resulted in 1,843 linked records. This is the first known study of this magnitude completed in North Carolina or in other published research. Preliminary data analysis revealed a marginally significant association between gender and a child receiving preschool early intervention (X2 (3) 6.73, p .08) and school age services (X2 (13) 20.2, p .09), with males being identified more often. Preliminary analysis also examined the effects of infant risk factors such as family financial status and family stability and support on later developmental outcomes. Surprisingly, results showed that neither of these risk factors were associated with later school age outcomes (X2 (1) .92, p .92) and (X2 (1) .13, p .72), respectively. Further analyses will examine pregnancy-related, child-related and family-related risk factors (e.g., maternal education, parental risk factors, birth weight, month of prenatal care, birth order, Apgar scores, etc.). These variables will be investigated to determine which early factor or combinations of factors are most predictive of infants' later poor developmental outcomes in the early school years. In sum, this study emphasizes the benefits of using developmental epidemiologic methods to estimate infant risk and predict later outcomes. It further demonstrates the feasibility of using combined data from a child's birth history, infancy and preschool years to estimate risk status. This research provides a quantitative basis for the accurate identification of at-risk infants. Cluett, S.E., Mulvihill, B.A., Wallander, J., & Hovinga, M. (1999). Applications of Developmental Epidemiological Data Linkage Methodology to Examine Early Risk for Childhood Disability. Developmental Review, in press. Scott, K. G., Shaw, K. H., & Urbano, J. C. (1994). Developmental epidemiology. In S. L. Friedman, & H. C. Haywood (Eds.), Developmental follow-up concepts, domains, and methods (pp. 351-374). New York: Academic Press.
poster
For infants and toddlers at-risk of or with a disability, an Individualized Family Service Plan(IFSP) is of utmost importance. Federal Part C guidelines mandate that an IFSP be developedfor each child with a disability, and that families be empowered to take an active role in itsdevelopment. A primary objective of Part C and the use of the IFSP is to insure that individualneeds of the child and family determine the services that families receive. However, widevariations in how and whether IFSPs are utilized exist throughout the United States. Moreover,previous research indicates that approximately 60% of services authorized on the IFSP areactually received by families (Perry, Greer, Mackey-Andrews & Goldhammer, 1999). Currently,the authors are coding the information contained on approximately 1000 IFSPs throughout thestate of Ohio. The IFSP includes information related to child and family demographics,eligibility, age at referral, planned services, child and family outcomes, family concerns, sourceof funding, and estimated cost of services. In addition, the authors will have descriptions of thevariations in service systems for all 81 counties throughout Ohio. Ohio has a very decentralizedearly intervention model and thus wide variations exist in how Part C is implemented throughoutthe state. Local variations in early intervention services, funding, and interagency coordinatingefforts will be examined along with the IFSP data. One of the key issues is whether there arefunding patterns which explain differences in services in different counties. Early interventionservices in the United States are very much based in a medical model with Medicaid as aprimary source of funding (Kates, 1998; Goetze, Mackey-Andrews & Greer, 1999). These data will allow us to explore whether there are patterns of service that are associatedwith certain funding sources or whether services are associated with child eligibility and needsas expressed in family concerns. The IFSP results will also be compared with similar IFSPevaluations conducted in other states, such as Indiana and Utah (Goetze, Akers, & Judd, 1999;Roberts, Innocenti & Goetze, 1999). Funding model differences may affect the level of use andcompletion of IFSPs in these states. Some states now use the IFSP as the authorization forpayment for child services if the service is not on the IFSP it will not be reimbursed. The effectthat funding models have on IFSP use and completion, a federal mandate, will be discussed. The combination of data generated by the county descriptions and IFSP information is expectedto yield a rich picture of the early intervention systems operating throughout Ohio. Resultingfrom these activities, a discussion of possible improvements in IFSP development andimplementation and funding models within the State of Ohio will occur, taking into account otherstate models of early intervention service delivery and financing.
poster
During a seven week period in early 1990, 3 275 babies born to women resident in Soweto-Johannesburg were enrolled into a prospective birth cohort study called Birth to Ten. All womenattending antenatal clinics during the six months before enrollment were interviewed regarding theirsocial and medical history, as well as their attitudes to the pregnancy. >From this pool, informationis available on 1 289 children and their families with complete longitudinal data from the antenatalperiod, birth, 6-12 months, 2-3 years, 4-5 years and 7-8 years. At each interview stage, a largeamount of information was collected about the child and family, including nutrition, growth andhealth history; familial, household and social details; maternal behaviour including smoking andalcohol use; and a variety of psychological measures: motor and mental development (Bayley Scalesof Infant Development and the Denver Developmental Screening test), psychological adjustment(modified Richman and Graham, 1971), temperament (shortened Carey, 1970), maternal/ caregiverresponsiveness (Clarke-Stewart, 1973) and maternal emotional state (Pitt, 1968).Four per cent of the women delivered their babies before their 17th and 3% after their 39th birthday;18% of children were born with gestational ages of less than 37 weeks; 12% weighed less than2500gms. Two thirds of the women had received less than 10 years of formal education, and thesame proportion of mothers were legally unmarried. Only a third of the sample had access to anindoor water supply; 91% had electricity and 65% had television. Forty per cent of the womeninterviewed during their pregnancy said that they definitely did not want to be pregnant with thischild, and 20% of women reported symptomatology consistent with a clinical diagnosis of depressionsix to 12 months after the birth of the child. These statistics indicate a high prevalence of identifiedrisk indicators for psychological problems.By the age of 5 years, between 14% and 21% of children were classified as having behaviourproblems, depending on the system of categorization used and, by age 7-8 years, a third of thechildren were repeating either their first or second year of formal schooling. Analyses indicate thatrisks for the development of psychological problems in early childhood are multiply determined, withfactors clustering in the biological, social and caregiving domains. Boys are more vulnerable todevelop psychological problems in early childhood than are girls, and birthweight, socioeconomicstatus, and caregiver responsiveness are important influences from infancy through to the early schoolyears. Moreover, reciprocal risk effects operate between behaviour problems and indices ofdevelopmental status.