The long-chain polyunsaturated fatty acids (LC-PUFAs) docosahexaenoic acid (DHA) and arachidonic acid (ARA) occur in high levels in the brain and play a key role in brain growth and the operation of neurotransmitters. Infants supplemented with DHA show improved language and communication skills, and there is accumulating evidence that the early development of executive functions such as planning, working memory, and attention control are influenced by LC-PUFAs, especially DHA. Several studies have found significantly improved means-end problem solving at 9 and 10 months in infants given DHA-/ARA-supplemented formula, and similar results were shown for infants whose mothers were supplemented with DHA during pregnancy and breastfeeding. Long-term benefits of LC-PUFA supplementation in infancy have been reported in children aged 3-6 years. Follow-up studies of infants given DHA-/ARA-supplemented versus control formula have shown better performance on tests of impulsivity and attention control in the supplemented children, with indications of a dose-response relationship for DHA. LC-PUFAs (especially DHA) in postnatal infant diet influence the development of executive functions and other higher-order cognitive abilities, and have a long-term influence on the development of attention and information processing in later childhood.

BACKGROUNDS: The recommendation for enteral iodide intake for preterm infants is 30 to 40 mu g/kg per day and 1 mu g/kg per day for parenteral intake. Preterm infants are vulnerable to iodide insufficiency and thyroid dysfunction. The hypothesis tested whether, compared with placebo, iodide supplementation of preterm infants improves neurodevelopment.METHODES: A randomized controlled trial of iodide supplementation versus placebo in infants <31 weeks' gestation. Trial solutions (sodium iodide or sodium chloride; dose 30 mu g/kg per day) were given within 42 hours of birth to the equivalent of 34 weeks' gestation. The only exclusion criterion was maternal iodide exposure during pregnancy or delivery. Whole blood levels of thyroxine, thyrotropin, and thyroid-binding globulin were measured on 4 specific postnatal days. The primary outcome was neurodevelopmental status at 2 years of age, measured by using the Bayley Scales of Infant Development-Ill. The primary analyses are by intention-to-treat, and data are presented also for survivors.RESULTS: One thousand two hundred seventy-three infants (637 intervention, 636 placebo) were recruited from 21 UK neonatal units. One hundred thirty-one infants died, and neurodevelopmental assessments were undertaken in 498 iodide and 499 placebo supplemented infants. There were no significant differences between the intervention and placebo groups in the primary outcome: mean difference cognitive score, -0.34, 95% confidence interval (CI) -2.57 to 1.89; motor composite score, 0.21, 95% CI -2.23 to 2.65; and language composite score, -0.05, 95% CI -2.48 to 2.39. There was evidence of weak interaction between iodide supplementation and hypothyroxinemic status in the language composite score and 1 subtest score.CONCLUSIONS: Overall iodide supplementation provided no benefit to neurodevelopment measured at 2 years of age.

AimNeurodevelopment is a key outcome for many childhood trials and observational studies. Clinically important decisions may rest on finding relatively small differences in neurodevelopment between groups receiving complex and costly interventions. Our purpose was to determine whether studies which measure neurodevelopment report the numbers, training, and auditing of assessors and, for multiple assessor studies, whether the results were adjusted and if so by which method?MethodElectronic searches were conducted using Medline, Embase, Cinahl, PsycINFO, and the Cochrane Library. A study was eligible if it reported neurodevelopmental outcome in children resident in the UK, less than or equal to 18 years and was published between 2000 and 2015. Trials and observational studies were included.ResultsThree hundred and seven full papers were reviewed: 52% of papers did not report the number of assessors used; 21% used a single assessor; and 27% used multiple assessors. Thirty-five per cent mentioned that assessors were trained in the use of the neurodevelopmental tool; 13% of assessors were audited; and only 1% of studies adjusted statistically for the number of assessors.InterpretationAt the very least, the quality of reporting the use of assessors in these research publications is poor, while at worst, the variability of assessors may mask the true relationship between an intervention/observation and neurodevelopmental outcome.

CONTEXT:Relatively little is known in euthyroid populations about the changes in maternal thyroid hormones during pregnancy, the nature of the relationship to cord thyroid hormone levels, and subsequent infant neurodevelopment.OBJECTIVES:The aim of the study was to describe the relationship between maternal and cord thyroid hormone parameters and to describe their associations with neurodevelopment at 5.5 years.DESIGN:We conducted a follow-up of women and their children born at or over 37 weeks' gestation.MAIN OUTCOMES:We measured maternal levels of TSH, thyroid peroxidase antibody (TPOAb), thyroglobulin antibody (TgAb), T(4), and free T(4) (FT(4)) at 10 and 34 weeks and at delivery, and cord levels of T(4), FT(4), TPOAb, and TgAb. The association of cord thyroid hormone parameters with McCarthy scale scores adjusted for the major confounders of neurodevelopment.RESULTS:Fifteen percent of the women were TPOAb-positive, and 12% were TgAb-positive; the proportion of women with mildly elevated TSH levels increased during pregnancy with the maximum (14%) at delivery. Lower perceptual performance and motor scores were found with TgAb-positive women and lower perceptual performance scores with TgAb-positive cord levels; otherwise, unadjusted maternal levels of TPOAb, TgAb, and TSH and unadjusted cord levels of FT(4), TPOAb, and TgAb were not associated with neurodevelopment at 5.5 years. Low cord T(4) levels were associated with significant increments in four McCarthy scales: General Cognitive Index, Verbal, Quantitative, and Memory scales-increments that persisted after adjustment at 11.4, 7.8, 7.6, and 7.8 points, respectively.CONCLUSIONS:Lower levels of cord T(4) were associated with increments in the McCarthy scales in the domains that tested cognitive and verbal abilities at 5.5 years.

CONTEXT:Mild maternal thyroid dysfunction during early pregnancy is associated with poor neurodevelopment in affected offspring. Most studies are population based or are smaller populations of term/late preterm infants. No studies were found that focused on more preterm infants.OBJECTIVE:Our objective was to describe the relationship between mild maternal thyroid dysfunction at delivery of infants born ≤34 wk and neurodevelopment at 5.5 yr.DESIGN:The study design was follow-up of women and children recruited in Scotland between 1998 and 2001.MAIN OUTCOME:We evaluated delivery levels of maternal TSH, free T(4) (FT(4)), and T(4) and the association with McCarthy Scale scores adjusted for 26 confounders of neurodevelopment.RESULTS:Maternal serum levels and McCarthy scores were available for 143 women and 166 children. After adjustment for confounders, there were significant 3.2, 2.1, and 1.8 point decrements, respectively, in general cognitive index, verbal subscale, and the perceptual performance subscale for each milliunit per liter increment in maternal TSH. Maternal FT(4) levels were variably associated with neurodevelopment. After adjustment, significant associations were found for the general cognitive index, motor scale, and quantitative subscale; each picomole per liter decrease in FT(4) was associated with an increase of 1.5, 1.7, and 0.9 points, respectively. Maternal T(4) levels showed little relationship with neurodevelopment. None of the women in this analysis had overt hypothyroidism, but mild hypothyroidism was evident in 27%; thyroglobulin antibody (TgAb) was ≥ 40 U/ml in 28% of the women.CONCLUSIONS:Higher maternal levels of TSH at delivery of infants born preterm were associated with significantly lower scores on the general cognitive index at 5.5 yr.

CONTEXT:Transient hypothyroxinemia is the commonest thyroid dysfunction of premature infants, and recent studies have found adverse associations with neurodevelopment. The validity of these associations is unclear because the studies adjusted for a differing range of factors likely to influence neurodevelopment.OBJECTIVE:The aim was to describe the association of transient hypothyroxinemia with neurodevelopment at 5.5 yr corrected age.DESIGN:We conducted a follow-up study of a cohort of infants born in Scotland from 1999 to 2001 ≤34 wk gestation.MAIN OUTCOME MEASURES:We measured scores on the McCarthy scale adjusted for 26 influences of neurodevelopment including parental intellect, home environment, breast or formula fed, growth retardation, and use of postnatal drugs.RESULTS:A total of 442 infants ≤34 wk gestation who had serum T(4) measurements on postnatal d 7, 14, or 28 and 100 term infants who had serum T(4) measured in cord blood were followed up at 5.5 yr. Infants with hypothyroxinemia (T(4) level ≤ 10th percentile on d 7, 14, or 28 corrected for gestational age) scored significantly lower than euthyroid infants (T(4) level greater than the 10th percentile and less than the 90th percentile on all days) on all McCarthy scales, except the quantitative. After adjustment for confounders of neurodevelopment, hypothyroxinemic infants scored significantly lower than euthyroid infants on the general cognitive and verbal scales.CONCLUSIONS:Our findings do not support the view that the hypothyroxinemic state, in the context of this analysis, is harmless in preterm infants. Many factors contribute both to the etiology of hypothyroxinemia and neurodevelopment; strategies for correction of hypothyroxinemia should acknowledge its complex etiology and not rely solely on one approach.

ABSTRACTResearch has shown that a relationship exists between phonological awareness and literary skills. It has been suggested that a structured programme of musical activities can be used to help children develop a multi‐sensory awareness and response to sounds. The relationship between musical ability and literacy skills was examined in a study that showed an association between rhythmic ability and reading. A further pilot intervention study showed that training in musical skills is a valuable additional strategy for assisting children with reading difficulties.

How stories from media and social interactions shape parents' HPV vaccination decisions is poorly understood. We sought to characterize parents' exposure to such stories, as well as associations between story exposure and vaccination behavior. Study participants were 1263 parents of U.S. adolescents who had not yet completed the HPV vaccine series. In 2017, these parents completed an online survey about whether they had heard stories of people who were harmed by HPV vaccine or who got diseases HPV vaccine could have prevented. Almost half of parents had heard HPV vaccine stories, which were about vaccine harms only (19%), vaccine preventable diseases only (11%), or both (15%). Stories of harms more often came from social and traditional media; stories of preventable diseases more often came from conversations (all p < 0.01). Parents who heard only stories about harms were less likely than those who heard no stories to have initiated HPV vaccination (23% vs. 33%, aOR:0.48; 95% CI:0.33:0.69). They were more likely to have delayed (79% vs. 66%, aOR:2.00; 95% CI:1.09:3.71) or refused (72% vs. 24%, aOR:8.87; 95% CI:4.09:19.25) HPV vaccination. Exposure to both stories about harms and preventable diseases was similarly associated with initiation, delay and refusal. Exposure to only stories about preventable diseases was not associated with initiation, delay or refusal. In conclusion, stories of HPV vaccine harms may be associated more strongly with vaccination behavior than stories of HPV vaccine preventable diseases. Communication campaigns should consider strategies to elevate stories of preventable diseases in social and traditional media.