Erik Domellöf

Neurodevelopment, nutrition, and growth until 12 mo of age in infants fed a low-energy, low-protein formula supplemented with bovine milk fat globule membranes: a randomized controlled trial

BACKGROUND Observational studies have indicated that differences in the composition of human milk and infant formula yield benefits in cognitive development and early growth for breastfed infants. OBJECTIVE The objective was to test the hypothesis that feeding an infant formula with reduced energy and protein densities and supplemented with bovine milk fat globule membrane (MFGM) reduces differences in cognitive development and early growth between formula-fed and breastfed infants. DESIGN In a prospective, double-blind, randomized controlled trial, 160 infants <2 mo of age were randomly assigned to be fed an MFGM-supplemented, low-energy, low-protein experimental formula (EF) or a standard formula (SF) until 6 mo of age. The energy and protein contents of the EF and SF were 60 and 66 kcal/100 mL and 1.20 and 1.27 g/100 mL, respectively. A breastfed reference (BFR) group consisted of 80 infants. RESULTS At 12 mo of age, the cognitive score (mean ± SD) on testing with the Bayley Scales of Infant and Toddler Development, Third Edition, was significantly higher in the EF group than in the SF group (105.8 ± 9.2 compared with 101.8 ± 8.0; P = 0.008) but was not significantly different from that in the BFR group (106.4 ± 9.5; P = 0.73). The EF group ingested larger volumes of formula than did the SF group (864 ± 174 compared with 797 ± 165 mL/d; P = 0.022), fully compensating for the lower energy density. No significant differences in linear growth, weight gain, body mass index, percentage body fat, or head circumference were found between the EF and SF groups. CONCLUSIONS MFGM supplementation to infant formula narrows the gap in cognitive development between breastfed and formula-fed infants. Between 2 and 6 mo of age, formula-fed term infants have the capacity to upregulate their ingested volumes when the energy density of formula is reduced from 66 to 60 kcal/100 mL.

Impairment Severity Selectively Affects the Control of Proximal and Distal Components of Reaching Movements in Children with Hemiplegic Cerebral Palsy.

This study explored proximal‐to‐distal components during goal‐directed reaching movements in children with mild or moderate hemiplegic cerebral palsy (HCP); [seven females, four males; mean age 8y 6mo; SD 27mo], compared with age‐matched, typically developing children (seven females, five males; mean age 8y 3mo [SD 25mo]. Severity of HCP was assessed following the approach of Claeys et al. Optoelectronic registrations were made during unimanual reaching‐to‐grasp and reaching‐to‐hit movements with both the affected/non‐preferred and unaffected/preferred side. Regardless of task, the children with HCP, particularly those with moderate impairment, displayed less optimal spatiotemporal organization of movements performed with the affected arm. Compared with the goal to hit, and increasingly with more severe impairment, children with HCP adapted to the goal to grasp by recruiting augmented shoulder movements when reaching with the affected side. A resulting impact on distal kinematics was found in shorter, straighter, and less segmented movement paths. Thus, depending on severity of hemispheric lesions and task complexity, unilateral brain injuries in HCP may selectively affect neural pathways underlying both proximal and distal arm movement control. Levels of both ipsi‐ and contralateral activation in relation to side and lesion severity should be considered in future studies on prehension movements in HCP.

Handedness in preterm born children: A systematic review and a meta-analysis

It has been proposed that left and/or non-right handedness (NRH) is over-represented in children with a history of preterm birth because such births are associated with a greater incidence of insult to the brain. We report an approximate two-fold increase in left and/or non-right handedness based on a systematic search of the literature from 1980 to September 2010 for English-language articles reporting handedness status in preterm children compared with fullterm controls either as a main focus of the study or as a secondary finding. In total, thirty articles met the inclusion criteria. However, there was a great variation between the included studies in terms of objectives, population characteristics, sample size and methodologies used. While the majority of studies reported a higher incidence of NRH in preterm than fullterm children, this was not a consistent finding. A quality assessment was made to explore the differences in overall study quality and handedness assessment methodology between studies. A random-effects model meta-analysis was then performed to estimate the accumulated effect of preterm birth on handedness (18 studies; 1947 cases and 8170 controls). Preterm children displayed a significantly higher occurrence of NRH than fullterm children (odds ratio [OR]: 2.12; 95% confidence interval [CI]: 1.59-2.78). Sources of heterogeneity were investigated by supplementary meta-analyses considering studies with high or low overall and handedness assessment quality. Publication bias was assessed by Eggers test of the intercept and Duvall and Tweedies trim-and-fill method. The outcomes of these procedures did not jeopardize the overall finding of reliably increased OR for NRH in preterm children. The present review suggests that a preterm birth is indeed associated with a greater than two-fold likelihood of NRH. Several studies also explored the relationship between handedness and neuropsychological functioning (cognition mainly) with an array of methods. Although not without disagreement, this association was found to be concordant. Studying handedness in preterm children, therefore, is a potentially important index of hemispheric organization and cognitive and sensory-motor functions following neurodevelopmental disturbance.

Goal-directed arm movements in children with fetal alcohol syndrome: a kinematic approach.

Background:  Although many studies have documented deficits in general motor functioning in children with fetal alcohol syndrome (FAS), few have employed detailed measurements to explore the specific nature of such disabilities. This pilot study explores whether three‐dimensional (3D) kinematic analysis may generate increased knowledge of the effect of intrauterine alcohol exposure on motor control processes by detecting atypical upper‐limb movement pattern specificity in children with FAS relative to typically developing (TD) children.

Functional asymmetries in the stepping response of the human newborn: a kinematic approach

In order to investigate subtle expressions of functional asymmetries in newborn leg movements, kinematic registrations were made on a sample of 40 healthy fullterm newborn infants during performance of the stepping response. Time–position data were collected from markers attached to the hip, knee and ankle joints of the left and right leg, and movements of both legs recorded simultaneously. Findings included evident side differences in terms of smoother trajectories of the right leg as a consequence of less movement segmentation compared to the left leg. Additionally, analyses of intralimb coordination revealed side differences with regard to stronger ankle–knee couplings and smaller phase shifts in the right leg. The findings suggest that asymmetries in newborn stepping responses are present in terms of spatio-temporal parameters and intralimb coordination. No evidence of a lateral preference in terms of frequency of the first foot moved was found. The present study adds new understanding to the lateralized attributes of the stepping response in the human newborn and as such points to new directions of research on the nature of laterality in the future.

Training of goal directed arm movements with motion interactive video games in children with cerebral palsy – A kinematic evaluation

Abstract Objective: The main aim of this study was to evaluate the quality of goal-directed arm movements in 15 children with cerebral palsy (CP) following four weeks of home-based training with motion interactive video games. A further aim was to investigate the applicability and characteristics of kinematic parameters in a virtual context in comparison to a physical context. Method: Kinematics and kinetics were captured while the children performed arm movements directed towards both virtual and physical targets. Results: The children’s movement precision improved, their centre of pressure paths decreased, as did the variability in maximal shoulder angles when reaching for virtual objects. Transfer to a situation with physical targets was mainly indicated by increased movement smoothness. Conclusion: Training with motion interactive games seems to improve arm motor control in children with CP. The results highlight the importance of considering both the context and the task itself when investigating kinematic parameters.

Atypical functional lateralization in children with fetal alcohol syndrome

In order to explore effects of prenatal alcohol exposure on functional lateralization, item tasks measuring preferences of hand, foot, eye, and ear were administered to a sample of 23 children diagnosed with fetal alcohol syndrome (FAS) compared with typically developing (TD) children. In addition, a dichotic listening task was administered to a subsample of 11 children with FAS and a TD group of comparable age, sex and handedness. The children with FAS were characterized by increased nonright-handedness compared with TD children. No differences were evident for preferential use of foot, eye, or ear. Moreover, children with FAS displayed more right ear extinctions during dichotic listening relative to TD children, indicating a lack of right ear advantage. The results add to findings of decreased manual asymmetry and less left-lateralized speech perception in children with developmental disorders, and are further discussed in relation to the high incidence of callosal abnormalities in alcohol-exposed children.

Long-term influences of a preterm birth on movement organization and side specialization in children at 4-8 years of age.

This study explored upper-limb and head kinematics during unimanual goal-directed movements in children born preterm (PT) and full-term (FT) aged 4-8 years. Further, functional lateralization was investigated through side-specific kinematics and hand preference observations. Altogether, 141 children were included, divided into three sub-groups based on gestation week at birth (GW). Children born FT (38-41 GW) and moderately PT (33-35 GW) showed faster, smoother, and shorter movement trajectories than children born very PT (V-PT < 33 GW). Only children born FT expressed evident side differences that were characterized by smoother movements with the preferred side. Regarding hand preference, the children born V-PT showed increased rates of non-right-handedness compared with the other groups. Regardless of hand preference, the children born V-PT showed less well organized movements compared with the other groups. These findings suggest that spatio-temporal movement organization and side specialization at pre-/early school-age are affected by a PT birth, and more frequently so for children born before 33 GWs, indicating long-lasting influences on neuromotor development and specialization.

Short- and long-term effects of synchronized metronome training in children with hemiplegic cerebral palsy: A two case study

Background: Children with cerebral palsy (CP) require individualized long-term management to maintain and improve motor functions. The objective of this study was to explore potential effects of synchronized metronome training (SMT) on movement kinematics in two children diagnosed with spastic hemiplegic CP (HCP). Method: Both children underwent 4-weeks/12 sessions of SMT by means of the Interactive Metronome (IM). Optoelectronic registrations of goal-directed uni- and bimanual upper-limb movements were made at three occasions; pre-training, post completed training and at 6-months post completed training. Results: Significant changes in kinematic outcomes following IM training were found for both cases. Findings included smoother and shorter movement trajectories in the bimanual condition, especially for the affected side. In the unimanual condition, Case I also showed increased smoothness of the non-affected side. Conclusions: The observed short- and long-term effects on the spatio-temporal organization of upper-limb movements need to be corroborated and extended by further case-control studies.

Relations among upper-limb movement organization and cognitive function at school age in children born preterm.

Objective: To explore relations between aspects of upper-body spatiotemporal movement organization and intelligence in children born preterm at school age. Methods: Three-dimensional (3D) kinematic recordings of arm and head movements during a unimanual precision task were related to performance on the Wechsler Intelligence Scale for Children, 4th edition, in a sample of 32 children born preterm (gestational age, mean: 31.5 weeks [range: 22–35 weeks]; birth weight, mean: 1699 g [range: 404–2962 g]) at 6 years to 8 years with no diagnosed cognitive, sensory, or motor impairments compared with 40 age-matched control children born fullterm. Results: In the children born preterm, upper-limb movement duration and segmentation of movement trajectories were significantly associated with full-scale intelligence quotient independent of gestational age (GA) and sex. These effects pertained to the preferred side, characterized by more effective movement organization being linked with increased intelligence scores. The same relations were not seen in the controls. Within the children born preterm, a significant effect of GA was also found for some aspects of upper-limb movement organization. Full-scale intelligence quotient was within normal limits for both groups but significantly lower in the preterm (mean: 94.5 [range: 72–120]) compared with the fullterm (mean: 101.7 [range: 76–119]) born children. Conclusions: The findings demonstrate that, independent of GA, the spatiotemporal organization of upper-limb movements is partly associated with cognitive performance in children born preterm.