Miranda Hester

Ms. Hester is Content Specialist with Contemporary OB/GYN and Contemporary Pediatrics.

Childhood cognitive performance is very likely not set in stone and could in fact be modifiable in a number of ways. One of the key inequalities could be linked with racial disparities. An 

 looks at what modifiable factors could help improve cognitive test scores.

Researchers ran a longitudinal pregnancy cohort study that looked at mother-child pairs who were enrolled in the University of Tennessee Health Science Center–Conditions Affecting Neurodevelopment and Learning in Early Life study, which ran from December 2006 to July 2011. The children were examined every year until they were aged 4 to 6 years. Environment-wide associations were examined through 155 prenatal, perinatal, and postnatal exposures. The cohorts sample of mothers included pregnant women who were recruited when they were at 16 to 28 weeks of gestation and were receiving care at 4 hospitals in Shelby County, Tennessee. High-risk pregnancies were excluded from the study.

There were 1055 children included in the study. Twenty-four factors were examined. The researchers noted links between child cognitive performance and parental education as well as breastfeeding. With each increase of 1.0 standard deviation in exposure, positive links were seen with fostering cognitive growth from maternal reading ability (β = 1.42; 95% CI, 0.16-2.68) as well as observed parent-child interactions (β = 1.12; 95% CI, 0.24-2.00). A negative association was found with parenting stress (β = −1.04; 95% CI, −1.86 to −0.21). The researchers found that a moderate increase in the beneficial exposures were linked with a noted improvement in estimated cognitive testing scores when using marginal means (0.5% of a standard deviation). Overall black children had fewer beneficial cognitive performance exposures.

The investigators concluded that there were a number of beneficial cognitive performance exposures that were modifiable and also linked with mean differences in cognitive performance by race. They believe that the study could guide other studies that are focused on decreasing racial disparities found in childhood cognitive performance.

1. LeWinn K, Bush N, Batra A, Tylavsky F, Rehkop D. Identification of modifiable social and behavioral factors associated with childhood cognitive performance. 

. September 21, 2020. Epub ahead of print. doi:10.1001/jamapediatrics.2020.2904

Articles

A new investigation looks at the modifiable factors that can impact childhood cognitive performance.

How modifiable is childhood cognitive performance?

An extremely low birth weight can be linked with many less than optimal outcomes in life. A 

 examines whether extremely low birth weight combined with early hypoxemic respiratory failure to impact survival and neurodevelopmental impairment in young children aged 18 to 26 months.

 The study also examined whether exposure to inhaled nitric oxide improved the outcomes for African American infants who had early hypoxemic respiratory failure.

The researchers used the Neonatal Research Network to find infants who had a weight ≤ 1000g, had a gestational age ≤ 26 weeks, had maximal oxygen ≥ 60% on either day 1 or day 3, were labeled early hypoxemic respiratory failure, and were born between 2007 to 2015. They used a propensity score regression model to analyze the outcomes.

There were 7639 infants with extremely low birth weight who were born ≤ 26 weeks. In this group, 22.7% of the infants had early hypoxemic respiratory failure. The investigators found that early hypoxemic respiratory failure was linked with a mortality of 51.3%. They also found the incidence of moderate-to-severe neurodevelopmental impairment was 41.2% in infants at 18 to 26 months of age. Among the infants who were treated with inhaled nitric oxide, the mortality was found to be 59.4%. Intact survival was linked to a complete course of antenatal steroids (adjusted odds ratio [aOR]: 1.6, 95% CI: 1.1–2.2), being female (aOR: 2.4, 95% CI: 1.8–3.3), and having a birth weight ≥ 720 g. Infants who were African American were found to have a similar incidence of early hypoxemic respiratory failure, 21.7% versus 23.3%. However, they were found to have lower exposure to inhaled nitric oxide, 16.4% versus 21.6%. Intact survival, which meant no death or neurodevelopmental impairment, had no significant difference between African-American infants and other races (aOR: 1.5, 95% CI: 0.6–3.6), when looking at infants with hypoxemic respiratory failure who were exposed to inhaled nitric oxide.

The researchers concluded that early hypoxemic respiratory failure in infants with ≤ 26 weeks is linked with both high mortality and high neurodevelopment impairment at 18 to 26 years. Additionally, the use of inhaled nitric oxide was not found to decrease either mortality or neurodevelopment and those outcomes were not different among African American infants.

1. Chandrasekharan P, Lakshminrusimha S, Chowdhury D, et al. Early hypoxic respiratory failure in extreme prematurity: mortality and neurodevelopmental outcomes. 

. September 17, 2020. Epub ahead of print. doi:10.1542/peds.2019-3318

Extreme low birth weight is linked to suboptimal outcomes. A new report looks at how early hypoxemic respiratory failure and extreme low birth weight can influence survival.

Impact of extreme low birth weight and early hypoxemic respiratory failure on survival

A mother’s health during the end of pregnancy and the first weeks following delivery can have an impact on not only her health outcomes, but her offspring’s as well. A 

 looked at the effect that maternal perinatal depression and anxiety had on the offspring’s development in the first 18 years of life.

The investigators used 6 databases: CINAHL Complete, Cochrane Library, Embase, Informit, MEDLINE Complete, and PsycInfo, to search for studies that reported information on the link between perinatal maternal mental health problems and offspring development. They included studies that were published in English, had a human sample, collected quantitative data, utilized a longitudinal design, examined measures of perinatal depression as well as development in the offspring, and investigated whether there was a link between perinatal depression or anxiety and childhood development.

The researchers found 191 unique studies that met their criteria, which created a combined sample of 195,751 unique mother-child pairs. They found that maternal perinatal depression and anxiety were linked with poorer development in the following areas:

cognitive (antenatal period, r = −0.12 [95% CI, –0.19 to –0.05]; postnatal period, r = −0.25 [95% CI, –0.39 to –0.09])

language (antenatal period, r = −0.11 [95% CI, −0.20 to 0.02]; postnatal period, r = −0.22 [95% CI, −0.40 to 0.03])

adaptive behavior (antenatal period, r = −0.26 [95% CI, −0.39 to −0.12])

offspring social-emotional (antenatal period, r = 0.21 [95% CI, 0.16-0.27]; postnatal period, r = 0.24 [95% CI, 0.19-0.28])

motor (antenatal period, r = −0.07 [95% CI, −0.18 to 0.03]; postnatal period, r = −0.07 [95% CI, −0.16 to 0.03])

The investigators found that this went beyond only the infant years and lasted into both childhood and adolescence. The robust nature of the results was confirmed through meta-regression.

They concluded that maternal anxiety and depression in the perinatal period did have a negative association with the child’s development. The results indicated that preventing depression and anxiety in this period as well as utilizing early interventions could have positive impact on the development of many children.

For more on maternal depression's impact on a child's development, click 

1. Rogers A, Obst S, Teague S et al. Association between maternal perinatal depression and anxiety and child and adolescent development. 

. September 14, 2020. Epub ahead of print. doi:10.1001/jamapediatrics.2020.2910

A mother’s health during pregnancy and in the first weeks following delivery can have an impact on her future health. A new report looks at how her mental health could also impact her child’s development through not only infancy, but childhood and adolescence.

Impact of a mother’s perinatal depression on a child’s development

There is no level of lead exposure that is without risk. Exposure to lead in childhood leads to irreversible neurodevelopmental deficits, which sets children up for a lifetime of suboptimal outcomes. Unfortunately, lead exposure prevention is only secondary in nature. An investigation in 

 assesses whether a machine learning model was better than regression in predicting childhood lead poisoning.

Researchers ran a prognostic study that used data from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program linked to the Chicago Department of Public Health. The participants came from a development cohort of children and a validation WIC cohort. Blood lead levels were assessed until December 2018.

There were 6812 children in the WIC validation cohort, which was comprised of mostly Hispanic and non-Hispanic Black children. The median year for house construction in the cohort was 1919. The machine learning prediction model’s area under the curve was 0.69, whereas the logistic regression’s area under the curve was 0.64 (difference, 0.05; 95% CI, 0.02-0.08). When the models were used to predict the 5% of children who were at the highest risk of having elevated blood lead levels, the machine learning model had a positive predictive value of 15.5% and the regression had a predictive value of 7.8% (difference, 7.7%; 95% CI, 3.7%-11.3%). In this same group, the sensitivity was 16.2% for machine learning and 8.1% for the regression (difference, 8.1%; 95% CI, 3.9%-11.7%) and the specificity was 95.5% and 95.1%, respectively (difference, 0.4%; 95% CI, 0.0%-0.7%)

The investigators concluded that the machine learning model was better at predicting childhood lead poisoning than regression. The machine learning was particularly good at identifying children who were at the highest risk of being exposed to lead. The findings are particularly important because many agencies have limited resources to proactively prevent lead exposure. The study’s results indicate that predicting lead exposure is difficult, but utilizing the machine learning model could help agencies use proactive measures to prevent exposure among children who are at the greatest risk.

1. Potash E, Ghani R, Walsh J, et al. Validation of a machine learning model to predict childhood lead poisoning. 

. 2020;3(9):e2012734. doi:10.1001/jamanetworkopen.2020.12734

No level of exposure to lead is safe and predicting exposure can be difficult. An investigation assesses the effectiveness of a machine learning model in predicting lead exposure.

Author | Miranda Hester

Articles

How modifiable is childhood cognitive performance?

Impact of extreme low birth weight and early hypoxemic respiratory failure on survival

Impact of a mother’s perinatal depression on a child’s development

Predicting lead exposure with a machine learning model