Overview of Perinatal Practices with Potential Neurodevelopmental Impact for Children Affected by Preterm Birth

Vohr, Betty R.; Brumbaugh, Jane E.; Hintz, Susan R.

doi:10.1016/j.jpeds.2021.10.015

Cited by 3 publications

(2 citation statements)

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“…12 Our authors identified neonatal care practices that can improve these outcomes. 13 However, most recent publications of neurodevelopmental outcomes of children born preterm do not have control groups. Without the regional cohort and carefully identified control group reported by Saigal et al, we do not know if we have improved outcomes and how to close the gaps in outcomes between infants born preterm and those born at term.…”

Section: Inspiring Authors Today: the Mcmaster Cohort Of Extremely Lo...mentioning

confidence: 99%

The Journal of Pediatrics Turns 90! A Perspective on Progress, Opportunities, and Challenges

Balistreri

Daniels

Welch

et al. 2022

The Journal of Pediatrics

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Section: Inspiring Authors Today: the Mcmaster Cohort Of Extremely Lo...mentioning

confidence: 99%

The Journal of Pediatrics Turns 90! A Perspective on Progress, Opportunities, and Challenges

Balistreri

Daniels

Welch

et al. 2022

The Journal of Pediatrics

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“…They incur nine times more inpatient visits than children without special healthcare needs (Kuo et al, 2015). Despite what is known about hospitalization's effects on neurodevelopment in children, the hospital environment is often overlooked as a contributor to poor neurodevelopmental outcomes (Vohr et al, 2022).…”

Section: Introductionmentioning

confidence: 99%

Time‐motion observations to characterize the developmental environment in a paediatric post‐acute care hospital

Hogan,

Wallace,

Schaffer‐Nay

et al. 2023

Child

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BackgroundChronically hospitalized children are at risk for neurodevelopmental delay, compounded by restricted social interactions, movement and environmental stimulation. We measured patients' movements and interactions to characterize developmentally relevant aspects of our inpatient environment and identify opportunities for developmental enrichment.MethodsAs part of a quality improvement initiative to inform neurodevelopmental programming for children with medical complexity at our paediatric post‐acute care specialty hospital, we conducted >232 hours of time‐motion observations. Trained observers followed 0‐ to 5‐year‐old inpatients from 7 am to 7 pm on weekdays, categorizing observations within five domains: Where, With, Position, State and Environment. Observations were collected continuously utilizing REDCap on iPads. A change in any domain initiated a new observation.ResultsPatients were median 1 year and 8 months of age (range 2 months to 3 years 9 months) with a median length of hospitalization of 514 days (range 66–1298). In total, 2636 unique observations (or median 134 observations per patient‐day [range 95–210]) were collected. Patients left their rooms up to 4 times per day for median 1 h and 34 min (range 41 min to 4 h:30 min). Patients spent 4 h:6 min (2 h:57 min to 6 h:30 min) interacting with someone and 3 h:51 min (57 min to 6 h:36 min) out of bed each day. Patients were simultaneously out of their beds, interacting with someone and awake for 2 h:21 min (51 min to 4 h:19 min) each day.ConclusionsDespite a care model prioritizing time out of bed and social interaction, time‐motion observations indicate patients spent many of their waking hours in bed and alone. Quantifying our inpatients developmental opportunities will inform neurodevelopmental programming initiatives.

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Developing a practical neurodevelopmental prediction model for targeting high-risk very preterm infants during visit after NICU: a retrospective national longitudinal cohort study

Chung,

Chen,

Chen

et al. 2024

BMC Med

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Background Follow-up visits for very preterm infants (VPI) after hospital discharge is crucial for their neurodevelopmental trajectories, but ensuring their attendance before 12 months corrected age (CA) remains a challenge. Current prediction models focus on future outcomes at discharge, but post-discharge data may enhance predictions of neurodevelopmental trajectories due to brain plasticity. Few studies in this field have utilized machine learning models to achieve this potential benefit with transparency, explainability, and transportability. Methods We developed four prediction models for cognitive or motor function at 24 months CA separately at each follow-up visits, two for the 6-month and two for the 12-month CA visits, using hospitalized and follow-up data of VPI from the Taiwan Premature Infant Follow-up Network from 2010 to 2017. Regression models were employed at 6 months CA, defined as a decline in The Bayley Scales of Infant Development 3rd edition (BSIDIII) composite score > 1 SD between 6- and 24-month CA. The delay models were developed at 12 months CA, defined as a BSIDIII composite score < 85 at 24 months CA. We used an evolutionary-derived machine learning method (EL-NDI) to develop models and compared them to those built by lasso regression, random forest, and support vector machine. Results One thousand two hundred forty-four VPI were in the developmental set and the two validation cohorts had 763 and 1347 VPI, respectively. EL-NDI used only 4–10 variables, while the others required 29 or more variables to achieve similar performance. For models at 6 months CA, the area under the receiver operating curve (AUC) of EL-NDI were 0.76–0.81(95% CI, 0.73–0.83) for cognitive regress with 4 variables and 0.79–0.83 (95% CI, 0.76–0.86) for motor regress with 4 variables. For models at 12 months CA, the AUC of EL-NDI were 0.75–0.78 (95% CI, 0.72–0.82) for cognitive delay with 10 variables and 0.73–0.82 (95% CI, 0.72–0.85) for motor delay with 4 variables. Conclusions Our EL-NDI demonstrated good performance using simpler, transparent, explainable models for clinical purpose. Implementing these models for VPI during follow-up visits may facilitate more informed discussions between parents and physicians and identify high-risk infants more effectively for early intervention.

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Overview of Perinatal Practices with Potential Neurodevelopmental Impact for Children Affected by Preterm Birth

Cited by 3 publications

References 137 publications

The Journal of Pediatrics Turns 90! A Perspective on Progress, Opportunities, and Challenges

The Journal of Pediatrics Turns 90! A Perspective on Progress, Opportunities, and Challenges

Time‐motion observations to characterize the developmental environment in a paediatric post‐acute care hospital

Developing a practical neurodevelopmental prediction model for targeting high-risk very preterm infants during visit after NICU: a retrospective national longitudinal cohort study

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