Deirdre M. Murray

Touch-screen technology usage in toddlers

Objective To establish the prevalence and patterns of use of touch-screen technologies in the toddler population. Design Parental questionnaires were completed for children aged 12u2005months to 3u2005years examining access to touch-screen devices and ability to perform common forms of interaction with touch-screen technologies. Results The 82 questionnaires completed on typically developing children revealed 71% of toddlers had access to touch-screen devices for a median of 15u2005min (IQR: 9.375–26.25) per day. By parental report, 24u2005months was the median age of ability to swipe (IQR: 19.5–30.5), unlock (IQR: 20.5–31.5) and active looking for touch-screen features (IQR: 22–30.5), while 25u2005months (IQR: 21–31.25) was the median age of ability to identify and use specific touch-screen features. Overall, 32.8% of toddlers could perform all four skills. Conclusions From 2u2005years of age toddlers have the ability to interact purposefully with touch-screen devices and demonstrate a variety of common skills required to utilise touch-screen technology.

Eating behaviour and weight status at 2 years of age: data from the Cork BASELINE Birth Cohort Study

Background/Objectives:To conduct an analysis of associations between eating behaviours and weight status in 2-year-old children.Subjects/Methods:Data were collected prospectively in the maternal-infant dyad Cork BASELINE Birth Cohort Study. The weight status of children aged 2 years (n=1189) was assigned using the International Obesity Task Force BMI cutoffs using measured heights and weights. Eating behaviours were assessed using the Children’s Eating Behaviour Questionnaire (CEBQ).Results:Eighty percent of children were of normal weight, 14% were overweight or obese and 6% were underweight. From the CEBQ, food approach behaviours including Enjoyment of Food (odds ratio (OR)=1.90, 95% confidence interval (CI)=1.46–2.48) and Food Responsiveness (OR=1.73, 95% CI=1.47–2.03) were associated with overweight/obesity (all P<0.001). The food avoidant behaviours of Satiety Responsiveness (OR=2.03, 95% CI=1.38–2.98) and Slowness in Eating (OR=1.44, 95% CI=1.01–2.04) were associated with underweight at 2 years (all P<0.05).Conclusions:Eating behaviours are associated with weight status as early as 2 years of age.

Early life factors associated with the exclusivity and duration of breast feeding in an Irish birth cohort study

OBJECTIVEnto investigate the influence of parental and infant characteristics on exclusive breast feeding from birth to six months of age and breast feeding rates at two, six and 12 months of age in Ireland.nnnMETHODOLOGYnsecondary data analysis from the Cork BASELINE Birth Cohort Study (http://www.baselinestudy.net/). Infants were seen at birth and two, six, and 12 months of age. Maternal and paternal history, neonatal course and feeding data were collected at birth and using parental questionnaires at each time point.nnnPARTICIPANTSn1094 singleton infants of primiparous women recruited at 20 weeks gestation who were breastfeeding on discharge from the maternity hospital.nnnFINDINGSnat discharge from the maternity hospital and at two months, neonatal intensive-care unit admission had the strongest influence on exclusive breast feeding status (adjusted OR 0.17, 95% CI 0.07-0.41 at discharge) and at two months (adjusted OR=0.20, 95% CI 0.05-0.83). A shorter duration of breast feeding was significantly associated with younger maternal age, non-tertiary education, Irish nationality and neonatal intensive-care unit admission. There was a significant difference in the duration of any breast feeding between infants who were and were not admitted to the neonatal intensive-care unit, 28(10.50, 32) weeks versus 32(27, 40) weeks. Mothers whose maternity leave was between seven and 12 months (adjusted OR=2.76, 95% CI 1.51-5.05) breast fed for a longer duration compared to mothers who had less than six months of maternity leave.nnnKEY CONCLUSIONSnadmission to the neonatal intensive care unit negatively influenced both exclusivity and duration of breast feeding. Length of maternity leave, and not employment status, was significantly associated with duration of breast feeding.nnnIMPLICATIONS FOR PRACTICEnadditional support may be required to ensure continued breast feeding in infants admitted to the neonatal intensive-care unit. Length of maternity leave is a modifiable influence on breast feeding and offers the opportunity for intervention to improve our rates of breast feeding.

The ability of early serial developmental assessment to predict outcome at 5 years following neonatal hypoxic-ischaemic encephalopathy

BACKGROUNDnNeurodevelopmental difficulties in children following hypoxic-ischaemic encephalopathy (HIE) may not emerge until school age.nnnAIMSnTo evaluate the value and stability of early serial developmental assessments in predicting long-term outcome.nnnSTUDY DESIGNnProspective study of infants with neonatal HIE and early continuous EEG at birth.nnnSUBJECTSnTerm infants with HIE were recruited at birth. Development was measured at 6, 12 and 24months using the Revised Griffiths Scales (GMDS-R).nnnOUTCOME MEASURESnIntellectual abilities at age five were measured using the Wechsler Preschool & Primary Scale of Intelligence (WPPSI-IIIUK) and the numbers subtest from the Childrens Memory Scale. Overall five-year outcome was also reported.nnnRESULTSnIQ outcome was available in forty-seven surviving children (28 male, 19 female: mean (SD) age 64.0(5.7) months. Mean processing speed (p=0.01) and short-term verbal memory (p=0.005) were below the norm. Global development (GDQ) at 6, 12 and 24months correlated (p<0.01) with five-year global, verbal and performance IQ with improved correlation over time. Normal GDQ throughout early childhood predicted normal IQ at 5years (24month AUROC value=0.941, p=0.001). An abnormal early GDQ score at any stage in the first 24months had excellent negative predictive values, superior to those for neonatal Sarnat and EEG grading.nnnCONCLUSIONSnNormal early development predicts normal 5year IQ with prediction increasing over time. Repeated measurement is warranted due to instability of findings across the first two years. Follow-up for children with abnormal early development is warranted given high sensitivity for school-age global abnormal outcome.

Mild hypoxic ischaemic encephalopathy and long term neurodevelopmental outcome - A systematic review

AIMSnHypoxic ischaemic encephalopathy (HIE) remains a significant cause of long term neurodisability despite therapeutic hypothermia (TH). Infants with mild HIE, representing 50% of those with HIE, are perceived as low risk and are currently not eligible for TH [1]. This review examines the available evidence of outcome in term infants with mild HIE.nnnMETHODSnMedline, Embase and Cochrane Clinical Trials databases were searched in March 2017. Studies with well-defined HIE grading at birth and standardised neurodevelopmental assessment at ≥18u202fmonths were included. Abnormal outcome was defined as death, cerebral palsy or standardised neurodevelopmental test score more than 1 standard deviation below the mean.nnnRESULTnTwenty studies were included. Abnormal outcome was reported in 86/341 (25%) of infants. There was insufficient evidence to examine the effect of TH on outcome.nnnCONCLUSIONnA significant proportion of infants with mild HIE have abnormal outcome at follow up.

Impact of maternal, antenatal and birth-associated factors on iron stores at birth: data from a prospective maternal|[ndash]|infant birth cohort

Background/Objectives:Low serum ferritin concentrations at birth, which reflect neonatal iron stores, track through to early childhood and have been associated with poorer neurodevelopmental outcomes. We aimed to identify maternal, antenatal and birth-associated factors that influence iron stores at birth in a prospective maternal–infant birth cohort.Subjects/Methods:In a population-based, longitudinal, birth cohort in Ireland, 413 maternal–infant dyads with prospectively collected lifestyle and clinical data from 15 weeks’ gestation had umbilical cord serum ferritin concentrations measured. Regression models were developed to identify independent factors associated with cord ferritin concentrations.Results:Median (IQR) cord ferritin concentrations were 185.7 (131.7, 385.5) μg/l, and 8% (n=33) of infants had low iron stores (ferritin <76u2009μg/l) at birth. Maternal obesity (BMI ⩾30u2009kg/m2) at 15 weeks’ gestation (adj. estimate (95% confidence interval (CI)): −66.4 (−106.9, −25.9) μg/l, P<0.0001) and delivery by caesarean section (−38.8 (−70.2, −7.4) μg/l, P=0.016) were inversely associated with cord ferritin concentrations. In addition, maternal smoking at 15 weeks’ gestation (adj. odds ratio (95% CI): 2.9 (1.2, 7), P=0.020) and being born small-for-gestational age (3.4 (1.3, 8.9), P=0.012) were associated with an increased risk of low iron stores (ferritin <76u2009μg/l) at birth.Conclusions:We have identified a number of potentially modifiable lifestyle factors that influence iron stores at birth, with the important role of overall maternal health and lifestyle during pregnancy highlighted. Public health policies targeting women of child-bearing age to improve nutrition and health outcomes should be prioritised for the health of the next generation.

Infant formula feeding practices in a prospective population based study

BackgroundIt is recommended that formula-fed infants are given standard whey-based infant formula throughout the first year of life, unless otherwise advised by healthcare professionals. To our knowledge it has not yet been explored if parents are using a whey-based infant formula throughout the first 12xa0months of life. Reasons for parental choice of formula are also unknown. Therefore, the objective of this paper was to describe parental administration of whey-based and non whey-based infant formula in the first year of life.MethodsData collected as part of the Cork BASELINE Birth Cohort Study examined infant feeding practices at 2, 6 and 12xa0months of age. Descriptive analysis explored infant feeding practices and parental reasons for changing from a whey-based to a non whey-based infant formula. Multiple logistic regression investigated parental and infant characteristics associated with the use of whey-based infant formula.ResultsIn total, 62.4%, 40.4% and 12.8% parent(s) at 2, 6 and 12xa0months, respectively, gave their infant whey-based infant formula. No parental or infant characteristic was found to consistently influence the use of whey-based infant formula. The most common reason reported by parent(s) for changing their infant’s formula to a non whey-based formula was that they perceived their baby as being hungry.ConclusionThe majority of parent(s) commence their infants on whey-based formula, but most change to non whey-based formula before 12xa0months of age. Parental perception of infant satiety and not healthcare advice was the most common reason for changing from a whey-based to a non whey-based infant formula. Additional research is now required to investigate the effect of whey-based and non whey-based infant formula on infant growth.

Early feeding and weaning in Irish infants in the Cork BASELINE birth cohort study

Increased risk for eczema and nutritional deficiencies are associated with early and late weaning, respectively (1) . Prospective data on infant feeding and weaning practices were collected as part of the Cork BASELINE birth cohort study. Primigravidae were recruited antenatally at 20 weeks gestation and their infants were examined at day 2 and at 2, 6 and 12 months. Questionnaires at each assessment captured early feeding and parents completed weaning diaries to document the first 6 weeks of transition to solid food. Data collected include body composition at 2 days and 2 months using air displacement plethysmography (PEAPOD), anthropometry, socio-demographic information, maternal and paternal allergies, home environment, pets, skin care, hygiene, illnesses and medication. Data extracted from weaning diaries include timing of first introduction to solid foods, description of food including ingredients; quantities consumed and gap between each new food. The major allergenic foods/ingredients (cow’s milk, wheat, eggs, shell-fish, fish, peanuts, tree nuts and soya (2) ) were of particular interest. Of the 1,537 maternal-infant dyads recruited at birth, weaning diaries were completed for 817 infants, of which 53 % are boys. Mean (SD) maternal age was 31 (3.8) years; 57 % of mothers worked in a professional or technical career and 45 % had a university education. Mean (SD) gestational age of infants was 39 (1.5) weeks and birth weight was 3.5 (0.5) Kg. According to WHO definitions (3) , 34, 4 and 37 % were exclusively, fully, and partially breastfed at discharge, respectively, and 25 % were formula-fed. At 2 months, 52, 30 and 18 % of infants were formula, breast and combination-fed, respectively. Of those receiving formula at 2 months, the median age in days they had last received breast-milk was 14 (IQR, 3-30). By 6 months, 14 % of babies were still receiving breast milk, in addition to solid food, formula or both. The median age of weaning to solids was 20 (IQR, 17-22) weeks and 81 % of infants were weaned between 17 and 26 weeks. 17 % of infants were weaned early ( < 17 weeks), with 28 and 45 % of those weaned at 15 and 16 weeks, respectively. Weaning beyond 26 weeks occurred in 20 (2%) infants. First weaning foods were baby rice (68%), infant breakfast cereals (14 %), carrots (4 %), apple (2 %) and other fruit/vegetables (10 %). The average gap between the first and second food was 7 days, with a mean of 15 (11.8) days between the first and fifth food. The mean number of different ingredients in the first 5 foods was 8 (4.1). At least one of the major allergenic foods/ ingredients was present in 65 % of weaning diaries; with cow’s milk (56 %), wheat (43%), soya (36%), egg (10 %) and fish (8 %) being identified. Weaning practices are broadly compliant with national recommendations with some significant deviations. Manufactured cereal products compared to home-prepared meals, were the primary source of exposure to the major allergenic foods and to more than one new food ingredients.

1099 Normative Levels of Interleukin 16 in Umbilical Cord Blood

Background and Aims The need for early and accurate prediction of outcome in Hypoxic-Ischemic Encephalopathy (HIE) remains critical. We have previously demonstrated that Interleukin 16 (IL-16) is raised in the umbilical cord blood of infants with moderate and severe HIE and has the potential to be developed as a predictive biomarker. Normal reference ranges for IL-16 in umbilical cord blood have not been previously described. The aim of this study was to determine normative levels of IL-16 in full term neonates using cord blood following uncomplicated deliveries. Methods Full term infants were recruited as part of an ongoing birth cohort study, the Cork BASELINE Birth Cohort Study. All had cord blood drawn and bio-banked at –80°C, within 3 hours of birth. Samples were chosen based on Apgar scores (≥8 at 1min, ≥9 at 5min), duration of ruptured membranes < 24 h, temperature in labour ≤37°C, gestational age ≥37 weeks and birthweight centile ≥10%. Analysis was performed on plasma EDTA, using ELISA Quantikine® (R&D Systems, Europe). Results The study consisted of samples from 48 infants with two different modes of delivery; unassisted vaginal delivery (n=12 male, n=12 female) and pre-labour elective caesarean section (n=12 male, n=12 female). The range of all samples was normally distributed between 87.0 and 114.6 pg/ml. Mean (SD) for IL-16 was 103.1 (± 21.9) pg/ml. Levels were not affected by gender or mode of delivery. Conclusion For the first time we have described the expected range of cord plasma IL-16 levels in healthy term infants.