Hilda Knobloch

Seasonal Variation in the Births of the Mentally Deficient

IT IS well known that the time at which injury to the developing fetus occurs results in a differential effect on the production of congenital anomalies. The embryonic stage, rather than the specific nature of the prenatal stress, appears to determine the type of malformation that will appear. Defects will manifest themselves in those organ systems that are undergoing the greatest amount of differentiation or organization at the time of the injury.1 In the central nervous system2 damage which occurs prior to the eighth week of fetal life usually results in gross anomalies, many of which are inoompatible with life. During the eighth to 12th week the cerebral cortex is undergoing its organization into the various molecular layers, and this period would be the critical time during which maternal stress would be apt to lead to those neuropsychiatric disabilities which result from cortical disorganization. Infectious diseases play prominent roles in the production of central nervous system damage. Congenital lues in the past was one of the major conditions which acted during fetal life to produce remote as well as immediate damage to the brain. In the more recent past reports have appeared about the effect of rubella in the first trimester of pregnancy in the production of several central nervous system defects. Viral infections operate in the postnatal period to damage the brain and their effects are easily observed. The influence of similar infections in the mother during pregnancy is not as easily subjected to investigation, but it may be equally if not more important. As a starting point, one of a series of neuropsychiatric disabilities-mental deficiency-was selected and a study designed to test the hypothesis that, because of the variation in the prevalence of viral infection, differences in the incidence of mental deficiency would occur which would be dependent on the season of birth. Infants conceived in the winter months it was postulated would have an increased incidence of mental deficiency when compared to infants conceived in the summer months, because of the increase in the prevalence of these infections during the colder seasons.

Geographic and Seasonal Variations in Births

IN previous investigations we have attempte,d to demonstrate the relationship of climatic variations during the first trimester of pregnancy to the b,irth of mentally deficient children. In the most recent study we tested the hypothesis that above-average summer temperatures during the third month of pregnancy, the critical period of fetal central nervous system development, are associated with an increased risk of being born mentally defective. This hypothesis was substantiated for the period of 1913-48 based on the date of birth, and therefore of conception, of mentally defective children admitted to the Columbus State

The Contribution of Some Organic Factors to School Retardation in Negro Children

The stereotype of the Negro school child as being duller, having a lower capacity to learn, possessing many specific learning disabilities, and presenting numerous problems of behavior and discipline is widespread. It served and is still serving the opponents of racial equality as a potent weapon in their efforts to maintain segregation. Because stereotypes have unfortunate and frequently vicious origins and effects, we have tended to brand them as completely false in toto. On the other hand, whenever any of the components of a stereotype have any validity, there is a tendency to accept both the stereotype and the action advocated by the stereotypers. As Dr. Campbell has stated in a Symposium on “Research and Race Differences in the Current Social Climate”, both attitudes are unfortunate.*

Considerations in evaluating changes in outcome for infants weighing less than 1,501 grams

Neonatal mortality for 285 infants and developmental outcome for 158 infants with birth weights of 751 to 1,500 gm, born in the Capital Regional Perinatal Center between July 1975 and December 1979, were compared with the findings in 1952, in 1965 to 1967, and in 1968 to 1970. In the 1,001- to 1,500-gm group, mortality decreased and there was an 18% incidence of major neuropsychiatric disability compared to the 48% found in 1952 when the same examination techniques and diagnostic criteria were used. More 751- to 1,000-gm infants survive now also, but 40% have a major handicap. There is a high incidence of preconceptional, prenatal, perinatal, and postnatal abnormalities in this group of very low-birth-weight infants, but the incidence is significantly higher in those with major disabilities. The infants who die and those who have subsequent major neuropsychiatric abnormalities require the sophisticated techniques of neonatal intensive care, whereas these procedures are not needed or are used only briefly for the infants who are normal. In upper New York State, the demographic shifts in race, age, parity, education, and induced abortions account for 13% of the drop in neonatal mortality in the 1,001- to 1,500-gm group. These demographic as well as social and medical care changes must be taken into account in any evaluation of the decreasing mortality and morbidity that has occurred. Improvements in prenatal, obstetric, and neonatal care appear to be doing for the 751- to 1,000-gm group now what the then high-level care in 1952 did for the 1,001- to 1,500-gm group, when mortality decreased but only half of those who survived were normal.

1344 CONSIDERATIONS IN EVALUATING CHANGES IN OUTCOME FOR INFANTS UNDER GRAMS

Neonatal mortality for 285 and developmental outcome for 135 inborn infants 751-1500 grams born from 7/75-12/79 were compared with the findings for prior decades and the influence of demographic, social and medical care changes accounted for. There is the expected mortality decrease in the 1001-1500 gram group, with an 18% incidence of major neuropsychiatric disability compared to the 48% found in 1952 by one of the present authors, using identical examination techniques and diagnostic criteria. More 751-1000 gram infants survive now, but 50% have a major handicap.All the infants have a higher incidence of adverse preconceptional, pre-,peri-, and postnatal abnormalities, but those who die or have major disabilities have significantly more. The abnormal infants and those who die require the sophisticated techniques of neonatal intensive care, while these procedures are not needed or are used briefly for the infants who are normal.The demographic shifts in race, age, parity, education and induced abortions account for some 22% of the drop in neonatal mortality in the 1001-1500 gram group. Improvements in medical, prenatal and neonatal care appear to be doing for the 751-1000 gram group now what the then high-level care in 1952 did for the 1000-1500 gram group, when mortality decreased but only 50% were normal.

The predictiveness of infant developmental diagnosis

The purposes of infant evaluation are to detect the child with organic disease of the brain and to identify factors which will modify the course of development. Follow-up of 199 infants seen between 16 and 52 weeks and re-evaluated at an average age of 7 years indicates the infant evaluation is highly predictive and points out some of the most important factors which affect school-age behavior. This report is confined to DQ (general developmental quotient)-IQ (Stanford-Binet) changes.Infant neurometor status and developmental quotient form the basic substrate, which is modified later by socioeconomic status and the occurrence of seizures after the infant examination.Of the 30 non-defective infants who fell to IQ 75 or less at school age, only one was not explainable by associated adverse factors, singly or in combination: i.e., abnormal infant neuro-motor status, subsequent seizures, lowest third in the socioeconomic scale or other specific diseases such as Downs or cretinism. In contrast, if the child is in the highest socioeconomic third his school-age function is good, even if adverse factors are present. Only 5 of the 48 children with IQs 106+ would not have been expected to achieve this level on the basis of their infant behavior; only one of these was in the lowest socioeconomic third.Perceptual-motor, language, school achievement and central nervous system integrative functions, as measured by a battery of tests at school age, were predicted at the same high level by the infant examination. The data indicate the importance of clinical judgment in diagnostic evaluation in infancy.