Parental developmental assessment of 18-month-old children: reliability and predictive value

Prospective assessment of early developmental markers and their association with neuropsychological impairment

Children who experience adversities in the pre-perinatal period are at increased risk of developing impairment later in life, despite the absence of overt brain and neurological abnormalities. However, many of these children exhibit sequelae several years after a period of normal appearance. As a result, the need for reliable developmental assessments for the early detection of infants at high risk of adverse neurodevelopmental outcomes has emerged. The Griffiths Mental Developmental Scales have a promising but poorly explored prognostic ability. This longitudinal study evaluated the predictive power of the Griffiths Mental Developmental Scales at 12 and 24 months on the cognitive and neuropsychological profile at 6 years of age in a sample of 70 children with a history of prematurity or perinatal asphyxia but without brain and neurological abnormalities. We found that the Griffiths Mental Developmental Scales at 24 months had good predictive ability on the intelligence quotient at 6 years and the capacity to predict some neuropsychological performances. On the other hand, the Griffiths Mental Developmental Scale at 12 months was not associated with the performance at 6 years or 24 months.   Conclusion: Data on brain development converge to indicate that the first two years of age represent a critical stage of development, particularly for children experiencing mild pre-perinatal adversities who are thought to exhibit white matter dysmaturity. For this reason, this age is crucial for identifying which children are at major risk, leaving enough time to intervene before overt deficits become apparent. Brain development in the first 2 years could explain the limited reliability of early neurodevelopmental testing. What is Known: • Pre-perinatal adversities increase the risk of developing neurodevelopmental disorders. • The predictive ability of the Griffith scale is poorly explored in low-grade conditions. What is New: • The predictive ability of the Griffith scale has been investigated in low-risk children. • A complete neuropsychological profile could offer a more accurate prediction than the intellectual quotient.

Early childhood parent-reported speech problems in small and large for gestational age term-born and preterm-born infants: a cohort study

OBJECTIVE

(1) To assess if preterm and term small for gestational age (SGA) or large for gestational age (LGA) infants have more parent-reported speech problems in early childhood compared with infants with birth weights appropriate for gestational age (AGA). (2) To assess if preterm and term SGA and LGA infants have more parent-reported learning, behavioural, hearing, movement and hand problems in early childhood compared with AGA infants.

DESIGN

Cohort study.

SETTING

Wales, UK.

PARTICIPANTS

7004 children with neurodevelopmental outcomes from the Respiratory and Neurological Outcomes of Children Born Preterm Study which enrolled 7129 children, born from 23 weeks of gestation onwards, to mothers aged 18-50 years of age were included in the analysis.

OUTCOME MEASURES

Parent-reported single-answer questionnaires were completed in 2013 to assess early childhood neurodevelopmental outcomes. The primary outcome was parent-reported speech problems in early childhood adjusted for clinical and demographic confounders in SGA and LGA infants compared with AGA infants. Secondary outcomes measured were parent-reported early childhood learning, behavioural, hearing, movement and hand problems.

RESULTS

Median age at the time of study was 5 years, range 2-10 years. Although the adjusted OR was 1.19 (0.92 to 1.55) for SGA infants and OR 1.11 (0.88 to 1.41) for LGA infants, this failed to reach statistical significance that these subgroups were more likely to have parent-reported speech problems in early childhood compared with AGA infants. This study also found parent-reported evidence suggestive of potential learning difficulties in early childhood (OR 1.51 (1.13 to 2.02)) and behavioural problems (OR 1.35 (1.01 to 1.79)) in SGA infants.

CONCLUSION

This study of 7004 infants in Wales suggests that infants born SGA or LGA likely do not have higher risks of parent-reported speech problems in early childhood compared with infants born AGA. To further ascertain this finding, studies with wider population coverage and longer-term follow-up would be needed.

Long-term health and neurodevelopment in children after antenatal exposure to low-dose aspirin for the prevention of preeclampsia and fetal growth restriction: A systematic review of randomized controlled trials

OBJECTIVE

To evaluate the long-term effects of antenatal aspirin exposure on child health and neurodevelopmental outcome beyond the perinatal period.

STUDY DESIGN

PubMed, Embase.com, the Cochrane Library and Web of Science were systematically searched from inception through 5 November 2020. We performed a cited-reference search and ClinicalTrials.gov was searched on 20 October 2020 to identify trial results that were not reported elsewhere. We included randomized controlled trials reporting on health-related outcomes in children (aged > 28 days) exposed to aspirin versus placebo or no treatment during pregnancy. Studies with any dose or duration of aspirin use were included. We excluded studies evaluating other antiplatelet agents or non-steroidal inflammatory drugs. Two authors independently performed study selection, data extraction and quality assessment. Quality assessment was performed using the Cochrane RoB2 tool for the original randomized controlled trials and the QUIPS for the follow-up studies. Results are presented as relative risks (RR) with 95% confidence intervals (95%CI).

RESULTS

The search yielded 6,907 unique records. Two studies were included, containing 4,168 children at age 12 months and 5,153 children at 18 months. Children were exposed to aspirin 50-60 mg versus placebo or no treatment. At 12 months, post-neonatal mortality was lower after allocation to aspirin (0.2% versus 0.5%; RR 0.28, 95%CI 0.08-0.99) in a single study. At 18 months, fewer children were found to have (gross and fine) motor problems (RR 0.49, 95%CI 0.26-0.91) after antenatal aspirin exposure in one study. No differences were found in mortality rate; the proportion of children with a short stature or low weight; or respiratory, hearing or visual problems at 18 months. Both included studies had a high risk of bias.

CONCLUSION

The two included studies showed evidence of potential benefit of antenatal low-dose aspirin on mortality and neurodevelopment up to the age of 18 months. Our findings support the current application of low-dose aspirin in pregnant women at risk for preeclampsia and fetal growth restriction. However, further follow-up research of children who were exposed to low-dose aspirin during pregnancy is of utmost importance to exclude potential long-term harm.

Developmental Organization, Stress, and Illness

The link between behavioral responsiveness to stress and subsequent health has been demonstrated in adults but not in infants and very young children. The ability of infants to suppress responding to acutely painful events was examined both as a function of neonatal status and as a predictor of incidence of illness at 18 to 24 months. Responding to stress in early infancy was predictive of later health but the nature of the relation depended on the maturity of the child.

Living with an inborn error of metabolism detected by newborn screening-parents' perspectives on child development and impact on family life

BACKGROUND

Newborn screening for inborn errors of metabolism is regarded as highly successful by health professionals. Little is known about parents' perspectives on child development and social impact on families.

METHODS

Parents of 187 patients with metabolic disorders detected by newborn screening rated child development, perceived burdens on child and family, and future expectations on a questionnaire with standardized answers. Parental ratings were compared with standardized psychometric test results. Regression analysis was performed to identify factors associated with extent of perceived burden.

RESULTS

In 26.2% of patients, parents perceived delays in global development and/or specific developmental domains (physical, social, intellectual, language). Parents expected normal future development in 95.7%, and an independent adult life for their child in 94.6%. Comparison with psychometric test results showed that parents of children with cognitive impairments tended to overrate their child's abilities. Mild/medium burden posed on the family (child) by the metabolic disorder was stated by 56.1% (48.9%) of parents, severe/very severe burden by 19.3% (8.6%). One third of families reported financial burden due to the metabolic disorder. Dietary treatment and diagnoses with risk for metabolic decompensation despite treatment were associated with higher perceived burden for the family. Disorders rated as potentially very burdensome by experts were not rated accordingly by parents, demonstrating different perspectives of professionals and parents.

CONCLUSION

Although newborn screening leads to favourable physical and cognitive outcome, living with a metabolic disorder may cause considerable stress on patients and families, emphasizing the need for comprehensive multidisciplinary care including psychological and social support.

Screening for developmental delay among children attending a rural community welfare clinic in Ghana

BACKGROUND

Periodic screening for developmental delays (DD) could avert the incidence of disability among children. However, such routine programme is yet to take off in rural welfare clinics in Ghana.

METHOD

Mothers of under-5 children who were attending rural child welfare clinic participated in this study. The socio-demographic data of the mothers and their children were recorded. The children were screened to assess their gross motor skills, fine motor skills, communication skills, problem solving/cognition and social/personal interaction using Ages and Stages Questionnaire. Score below the threshold points on a developmental domain defines DD for a child. Data analysis involved percentages and frequency while Chi-square was performed to determine the associations between the selected socio-demographic risk factors and DD. Alpha value was set at p < 0.05.

RESULTS

Three hundren and thirty (330) children were screened and majority 60(18%), were found within the age range 3 months 1 day to 5 months 0 day. 251(76%) had normal weight (2.5 kg-3.5) while 26(7.6%) were underweight (<2.5 kg). Generally, 147(44.6%) of the children had DD in the different domains of the questionnaires. 41(12.4%) had DD in social/personal interaction while 19(5.8%) were delayed in the communication domain. Birth weight and duration of gestation were significantly associated with communication domain while the level of education of the mothers and duration of gestation were significantly associated with gross motor domain.

CONCLUSION

An appreciable proportion of the children were found to experience developmental delays and the most prevalent occurence was in personal/social interaction. Birth weight, gestational age and maternal educational level provide insight into a link with communication and gross motor skills.

The Temporal Relation between Regression and Transition Periods in Early Infancy

According to the literature about developmental changes, periods of instability and disorganization in the social and emotional behavior in both human and non-human primate, infancy precedes major developmental achievements or transitions (Heimann, 2003; Sparrow & Brazelton, 2006). Developmental investigators have observed a more frequent and prolonged crying, clinging and bids for physical contact with mother during these periods of instability and disorganization. Some authors, according to Horwich (1974), called these periods regression periods. Rijt-Plooij and Plooij (1992) claimed that 10 regression periods could be identified during the first 20 months of human life. In an early study, Sadurní and Rostan (2002) confirmed the presence of 8 such regression periods during the first year of life of 18 Catalan babies. Their 8 regression periods were comparable to the first 8 of the 10 regression periods found by Van de Rijt Plooij and Plooij. The aim of the present study is to see whether the regression periods that we found are temporally related to some transition. We define a transition as the occurrence of a new developmental change in a child. In the present study we have used non-analyzed data from the same 18 Catalan babies (10 boys and 8 girls) as mentioned in our earlier published study on regression periods. The age of these babies was between 3 weeks and 14 months. Using a microgenetic methodology we have found 8 transitions periods in the first year of life. We have also observed a temporal relation between the regressions periods found earlier and the transition periods reported here.

Identification of children with language impairment: investigating the classification accuracy of the MacArthur-Bates Communicative Development Inventories, Level III

PURPOSE

This study tested the accuracy with which the MacArthur-Bates Communicative Development Inventories, Level III (CDI-III), a parent report measure of language ability, discriminated children with language impairment from those developing language typically.

METHOD

Parents of 58 children, 49 with typically developing language (age 30 to 42 months) and 9 with language impairment (age 31 to 45 months) completed the CDI-III, a 2-page questionnaire that includes 100 vocabulary items, 12 sentence pairs, and 12 questions regarding linguistic concepts.

RESULTS

A discriminant analysis indicated that the CDI-III total score together with age classified children into language status groups with 96.6% accuracy overall. The corresponding likelihood ratios supported this strong level of accuracy, although precision may not be as high as indicated by broad confidence intervals.

CONCLUSIONS

Results of this study contribute to the accumulating evidence on the types of valid inferences that may be made from the CDI-III, specifically its classification accuracy. Further research should continue to investigate classification accuracy in larger samples with broader maternal education levels and with different types of language impairments. Additional research should also investigate the classification accuracy when the CDI-III is used in combination with other tests.

Admissions of all gestations to a regional neonatal unit versus controls: 2-year outcome

AIMS

To assess neurodevelopmental outcome at 2 years for neonatal intensive care unit (NICU) admissions compared with controls, and to trial a parent-reporting scheme.

METHODS

All infants admitted to the NICU at Christchurch Women's Hospital over a 12-month period and whose parents were domiciled in a defined geographical region were eligible for study, together with every eighth term infant not admitted (to a total of 300). Parents completed a two-page questionnaire on their child's 2nd birthday. All infants <28 weeks gestation and a random 300 NICU admissions and 108 controls underwent a paediatric examination and Bayley II assessment at 2 years of age.

RESULTS

A total of 387 NICU infants (86% eligible) and 306 controls were enrolled. At 2 years of age, 276 NICU infants (89% survivors) and 94 controls (87%) had some follow up. For infants of <33 weeks, 33-36 weeks, > or =37 weeks gestation and controls, the percentage >1 SD below the mean on the Bayley Mental Development Index scales were 33.3, 36.5, 44.6 and 24.1, respectively (P= 0.03); on the Psychomotor Developmental Index scales were 30.0, 29.1, 41.1 and 19.5 (P= 0.02) and the percentage with any cerebral palsy were 11.1, 2.8, 5.2 and 1.2.

CONCLUSIONS

At 2 years of age, NICU graduates have more developmental problems than controls across a range of measures. In many cases, term NICU graduates have the least favourable outcome. There was only moderate agreement between parents' reporting of moderate or severe developmental disability by means of a questionnaire, compared with professionals (kappa statistic 0.38), with parents tending to underestimate problems.

Developmental assessment of preterm infants at 2 years: validity of parent reports

Parental questionnaires are inexpensive alternatives to standardized testing for outcome measurement. The Parent Report of Children's Abilities has previously been revised (PARCA-R) and validated for use with very-preterm infants at 2 years of age. This study revalidated the PARCA-R for assessing cognition in a larger and more inclusive sample of preterm infants. One hundred and sixty-four children (82 males, 82 females) of <32 weeks' gestation (median 29wks, interquartile range [IQR] 28-30wks); and median birthweight 1200g (IQR 925-1463g) were evaluated using the Mental Development Index (MDI) of the Bayley Scales of Infant Development - 2nd edition (BSID-II) at 2 years' corrected age. Parents completed the PARCA-R questionnaire. Significant correlations between PARCA-R Parent Report Composite (PRC) scores and MDI scores (r=0.77, 95% confidence interval [CI] 0.69-0.82, p<0.01) demonstrated concurrent validity. A receiver operating characteristic-determined PRC cut-off of <44 had optimal discriminatory power (area under curve 0.92) for identifying MDI <70, with 85% sensitivity (95% CI 0.58-0.96), 87% specificity (95% CI 0.81-0.92), 98% negative predictive value (95% CI 0.95-1), and 37% positive predictive value (95% CI 0.22-0.54). The PARCA-R has good concurrent validity and diagnostic utility for identifying cognitive delay in very-preterm infants at 2 years of age. It is useful for outcome measurement, developmental screening, and facilitating parental involvement at follow-up.

Outcome Monitoring in Preterm Populations

Routine neurodevelopmental follow-up is crucial in high-risk populations, such as those born very preterm. Even in the absence of severe neurosensory impairment, very preterm children are at risk for a range of long-term cognitive, motor, and learning deficits. Infant developmental assessments are typically carried out at 2 years of age for both clinical and research purposes, and they are crucial for outcome monitoring. We review psychometric tests of infant developmental functioning most widely used as outcome measures for very preterm infants and other high-risk populations. We also consider parent-based assessments and methodological issues pertaining to the use of these tools in large-scale research studies and in outcome monitoring in this population.

Determinants of response to a parent questionnaire about development and behaviour in 3 year olds: European multicentre study of congenital toxoplasmosis

BACKGROUND

We aimed to determine how response to a parent-completed postal questionnaire measuring development, behaviour, impairment, and parental concerns and anxiety, varies in different European centres.

METHODS

Prospective cohort study of 3 year old children, with and without congenital toxoplasmosis, who were identified by prenatal or neonatal screening for toxoplasmosis in 11 centres in 7 countries. Parents were mailed a questionnaire that comprised all or part of existing validated tools. We determined the effect of characteristics of the centre and child on response, age at questionnaire completion, and response to child drawing tasks.

RESULTS

The questionnaire took 21 minutes to complete on average. 67% (714/1058) of parents responded. Few parents (60/1058) refused to participate. The strongest determinants of response were the score for organisational attributes of the study centre (such as direct involvement in follow up and access to an address register), and infection with congenital toxoplasmosis. Age at completion was associated with study centre, presence of neurological abnormalities in early infancy, and duration of prenatal treatment. Completion rates for individual questions exceeded 92% except for child completed drawings of a man (70%), which were completed more by girls, older children, and in certain centres.

CONCLUSION

Differences in response across European centres were predominantly related to the organisation of follow up and access to correct addresses. The questionnaire was acceptable in all six countries and offers a low cost tool for assessing development, behaviour, and parental concerns and anxiety, in multinational studies.

Parents' evaluation of developmental status in children born with a birthweight of 1250 g or less

OBJECTIVE

To evaluate the agreement between parental reporting of development of children born very preterm using the Parents' Evaluation of Developmental Status (PEDS) questionnaire and professional assessment by a paediatric developmental team in the detection of sensorineural disability.

METHODS

A cross-sectional cohort study of 362 children born in Queensland with a birthweight < or = 1250 g, who were surviving at 2 and 4 years of age corrected for prematurity, was conducted. Parents completed the PEDS questionnaire prior to their child receiving a neurodevelopmental assessment. The level of agreement for sensorineural disability between the neurodevelopmental assessment and the parents' score on the PEDS questionnaire was measured using the kappa statistic, and screening test characteristics were calculated. Logistic regression was used to investigate factors that might affect agreement.

RESULTS

Two hundred and eighty-three (78%) of the eligible children were located and contacted. Of these, 216 (76%) agreed to participate in the study (110, 2-year-olds; 106, 4-year-olds). Agreement between the two forms of rating sensorineural disability (developmental quotient > -2SD (standard deviation), cerebral palsy, bilateral blindness and deafness requiring aids) for the 4-year age group children was fair (kappa = 0.27, P = 0.001). PEDS accurately identified 69% (11 of 16) of disabled children and 72% (65 of 90) non-disabled children. The test characteristics for these children were similar to Glascoe's norming sample with a PPV 31% (95% CI: 14-48%), specificity 72% (95% CI: 62-81%), but lower sensitivity 69% (95% CI: 62-81%) and higher false-negative rate 31% (95% CI: 11, 59). Agreement for the 2-year age group was fair with poor test characteristics. Other comparisons for both age groups (PEDS A and B compared using a disability status with DQ > -1SD) showed poor agreement and test characteristics. Gestation age < 27 weeks and maternal education at or below grade 10 in the 2-year age group were the only factors independently affecting agreement.

CONCLUSIONS

The agreement between parental evaluation of sensorineural disability status using PEDS and paediatrics developmental assessment in children born very preterm at 4-years corrected age for prematurity compares favourably with Glascoe's norming sample. The lower agreement seen in the 2-year age group limits the utility of PEDS to be used as a screen for disability at an age when early intervention may be useful. The PEDS questionnaire is designed and normed for the general paediatric population, and it is not clear if parents of children born very preterm may have interpreted the PEDS questionnaire in relation to their satisfaction with their child's developmental progress rather than their child's functional ability.

A comparison of findings on parents' and teachers' questionnaires, and detailed ophthalmic and psychological assessments

BACKGROUND

Questionnaires are important tools used to gain information about health and level of function in different domains.

AIMS AND METHODS

To determine the degree of agreement between questionnaires, administered to parents and teachers, and ophthalmic and psychological examinations in a cohort of 309 low birth weight children (<1701 g) at age 10-13 years.

RESULTS

A total of 90.9% of cases showed agreement between the question on distance vision and clinical assessment, and agreement for the near vision question was 83%. However, the correlation on an individual basis was only fair (kappa = 0.46, distance vision) to poor (kappa = 0.2, near vision). The overall agreement for the questions on cognitive ability was better than the correlation, whereas the questions on reading and mathematical ability showed low agreement and low correlation.

CONCLUSION

Questionnaire assessment of vision and cognitive ability is more suitable for studying the outcome of a large population than for identifying deficits in individuals.

Early identification of children with developmental disabilities

This paper provides an overview of research into early identification of children with developmental disabilities in child healthcare, especially those disabilities related to cognitive impairment. The review covers the following related topics: definition of the target group, the predictive value of developmental screening instruments and psychomotor tests, risk indexes, early intervention and evaluation of developmental screening programmes. Empirical research into child development and the predictive value of developmental tests is extensive. However, proportionally few, mostly cohort or case-control, studies focusing on evaluation of developmental screening programmes conducted within a clinical setting were found. Some sensitivity and most specificity rates reported fell within what is considered acceptable for developmental screening performed in the pre-school years, i.e. a sensitivity of more than 70% and a specificity between 70% and 80%. Overall, between 1-6% of the children screened were identified. Typically, most children with severe disabilities were identified prior to the screening or excluded from the studies reviewed. The shortcomings of developmental screening (instruments) and difficulties in early identification are discussed.

Nifedipine administered in pregnancy: effect on the development of children at 18 months

The safety of use of the calcium channel blocker nifedipine in pregnancy as it affects child development has not been well evaluated. We report the results, with regard to the safety for children of use of nifedipine in pregnancy, on children followed up at 18 months of age born from women recruited in a study comparing routine treatment with nifedipine compared with no treatment.

An investigation into aspects of the Mayo early language screening test

The concurrent validity and inter-tester agreement on the Mayo early language screening test (MELST), and the concurrent validity of parental anxiety about speech and language development as a screening measure were investigated. A sample (aged 18 months to 5 years) comprising 120 children referred to the Mayo speech and language therapy department during 1995 and 80 controls, was assessed on the MELST by their local public health nurse. Within a calendar month each child was reassessed on the MELST by the therapist, who also administered the Reynell developmental language scales (RDLS) and the Edinburgh articulation test (EAT) as criterion measures. Overall, the MELST achieved moderately high sensitivity and specificity measures. Phonological problems were identified with more accuracy than language problems and the test was equally sensitive to impairments in comprehension and expression. The test tended to over-refer and was least accurate in screening the language skills of children at the highest age level (4-5 years). A significant association was found between parental concern and pass/failure on each of the MELST, RDLS and EAT. As a screening measure, parental anxiety achieved high sensitivity, moderate specificity and a moderate positive predictive value. However, it also tended to over-refer, and was also least accurate in identifying speech and/or language disorders at the highest age level. Moderately high inter-tester agreement measures were found, with greater agreement between scoring for controls than referrals. The phonology sections were scored significantly higher by the public health nurses than by the therapist. The results of this study imply that the MELST is sufficiently accurate and reliable to recommend its continued use in child surveillance programmes.

Translation and adaptation of the revised Denver pre-screening developmental questionnaire for Madinah children, Saudi Arabia

A childâs development is largely connected with environment, and so tools used in developmental assessment and screening should be modified to match the local environment of children. The experience and findings of such modifications is important to child health workers. The objectives of this study were to describe the method applied in translating the Revised Denver Pre-screening Developmental Questionnaire (R-PDQ) as a developmental screening tool, and to describe and analyze changes introduced to the R-PDQ after translation, adaptation and validation for Saudi children. To adapt the R-PDQ, three steps were taken: translation from English to Arabic using cross-translation method, piloting the Arabic translation on 65 children and mothers, and conducting the questionnaire on a random sample of 1219 children to introduce final necessary changes. The English R-PDQ went through major changes to make it valid for use in Saudi culture for evaluation of a childâs development. Changes were made in the content of the questionnaire, age intervals, as well as normal age of developmental abilities and the order of acquiring them. Changes in the R-PDQ items were pertinent in language and personal-social items. No major changes were introduced in fine-motor or gross-motor items. This study demonstrates a model in adapting a developmental screening tool, and illustrates the need for standardization of âimportedâ developmental screening tools before using them.

Comparing two methods of follow up in a multicentre randomised trial

AIMS

To evaluate a parental questionnaire as a means of providing outcome measures for a multicentre randomised controlled trial of treatment for post-haemorrhagic ventricular dilatation.

METHODS

The parents of 88 survivors were sent a questionnaire before a paediatric assessment at the age of 30 months. The parents' responses to individual questions taken mainly from the Griffiths' mental development scales and their perception of the child's ability to see and hear were compared with the paediatric findings. A model, based on the parents' responses to particular questions, allowed the categorisation of the children as normal, impaired, moderately or severely disabled; this was compared with similar categorisation based on the full paediatric assessment.

RESULTS

Agreement on items concerning gross motor function ranged between 81 and 99%, concerning dressing between 77 and 80%, concerning feeding between 91 and 99%, and concerning language between 85 and 93%. Similar proportions of children were identified as disabled by the parents (60%) and by the paediatrician (66%). Of 29 children who had developmental quotients less than 70, parents identified 28 as disabled, 18 of them as severely disabled. They were not so good at identifying children with impairments without functional loss.

CONCLUSIONS

Further work is required but there is sufficient encouragement from the results to pursue this methodology further for use in comparing groups in randomised trials.

Australian Collaborative Trial of Antenatal Thyrotropin-Releasing Hormone: adverse effects at 12-month follow-up. ACTOBAT Study Group

OBJECTIVE

The Australian Collaborative Trial of Antenatal Thyrotropin-Releasing Hormone (ACTOBAT) assessed the efficacy of 200 microg of thyrotropin-releasing hormone (TRH) in combination with glucocorticoids in the prevention of neonatal lung disease. This paper reports the 12-month follow-up of the infants from the trial completed in 1994.

DESIGN

This was a double-blinded randomized controlled trial.

SETTING

Women were recruited from level 3 perinatal centers throughout Australia.

PARTICIPANTS

Mothers who had not withdrawn from treatment and whose infants were discharged alive (1262 infants). Extensive efforts were made to trace this entire cohort.

OUTCOME MEASURES

A questionnaire was mailed to parents for self-completion immediately before their baby's/babies' first birthday. The questionnaire included a checklist to assess sensory, motor, language, and social development, and use of health services.

RESULTS

Milestone scores were developed from items on the follow-up form. Treatment with TRH was associated with an increased risk of motor delay, social delay, fine motor delay, sensory impairment, and early language impairment. No differences were seen between treatment and placebo groups for motor impairment. Multivariate analyses were performed, adjusting for chronological age, duration of gestation at randomization, time from randomization to delivery, parity, history of perinatal death, history of preterm rupture of the membranes, infant sex, singleton or twin status, maternal age, and maternal blood pressure (systolic and diastolic) at randomization. For the total cohort (N = 1022), treatment with TRH was associated with motor delay (odds ratio [OR], 1.51; 95% confidence interval [CI] 1.11 to 2.05); social delay (OR 1.40; 95% CI 1.01 to 1.95); sensory impairment (OR, 2.00; 95% CI 1.06 to 3.74); severe impairment (OR, 1.75; 95% CI 1.07 to 2.87); and a trend toward motor impairment (OR, 1.50; 95% CI .97 to 2.33), early language impairment (OR, 1.27, 95% CI .90 to 1.79), and fine motor delay (OR, 1.15; 95% CI .83 to 1.60). There were no differences between the treatment groups in hospital admissions (OR, 1.08; 95% CI .83 to 1.42), doctors' visits (general practitioner OR adj, 1.09; 95% CI .79 to 1.50 or specialist OR adj 1.15; 95% CI .87 to 1.49), respiratory symptoms (OR adj, 1.16; 95% CI .88 to 1.53), or behavioral disturbances (OR adj, .93; 95% CI .71 to 1.21).

CONCLUSIONS

Because antenatal administration of TRH is associated with small, consistent deficits in major milestone achievements at 12 months of age, it is essential that additional planned trials make provision for long-term follow-up. Antenatal TRH should only be used in the context of a clinical trial.