Browsing by Author "Thorsten V"

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    Developmental trajectories of children with birth asphyxia through 36 months of age in low/low-middle income countries.
    (2014-Jul) Wallander JL; Bann C; Chomba E; Goudar SS; Pasha O; Biasini FJ; McClure EM; Thorsten V; Wallace D; Carlo WA; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia; University of Alabama at Birmingham, Birmingham, AL, United States.; KLE University's Jawaharlal Nehru Medical College, Belgaum, India.; Research Triangle Institute International, Durham, NC, United States.; University of Alabama at Birmingham, Birmingham, AL, United States.; University of California, Merced, Merced, CA, United States. Electronic address: Jwallander@ucmerced.edu.; Aga Kahn University Medical College, Karachi, Pakistan.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia; University of Zambia, Lusaka, Zambia.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
    BACKGROUND: Resuscitation following birth asphyxia reduces mortality, but may be argued to increase risk for neurodevelopmental disability in survivors. AIMS: To test the hypothesis that development of infants who received resuscitation following birth asphyxia is not significantly different through 36months of age from infants who had healthy births. STUDY DESIGN: Prospective observational cohort design comparing infants exposed to birth asphyxia with resuscitation or healthy birth. SUBJECTS: A random sample of infants with birth asphyxia who received bag-and-mask resuscitation was selected from birth records in selected communities in 3 countries. EXCLUSION CRITERIA: birth weight<1500g, severely abnormal neurological examination at 7days, mother<15years, unable to participate, or not expected to remain in the target area. A random sample of healthy-birth infants (no resuscitation, normal neurological exam) was also selected. Eligible=438, consented=407, and ≥1 valid developmental assessment during the first 36months=376. OUTCOME MEASURE(S): Bayley Scales of Infant Development-II Mental (MDI) and Psychomotor (PDI) Development Index. RESULTS: Trajectories of MDI (p=.069) and PDI (p=.143) over 3 yearly assessments did not differ between children with birth asphyxia and healthy-birth children. Rather there was a trend for birth asphyxia children to improve more than healthy-birth children. CONCLUSIONS: The large majority of infants who are treated with resuscitation and survived birth asphyxia can be expected to evidence normal development at least until age 3. The risk for neurodevelopmental disability should not justify the restriction of effective therapies for birth asphyxia.
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    Randomized trial of early developmental intervention on outcomes in children after birth asphyxia in developing countries.
    (2013-Apr) Carlo WA; Goudar SS; Pasha O; Chomba E; Wallander JL; Biasini FJ; McClure EM; Thorsten V; Chakraborty H; Wallace D; Shearer DL; Wright LL; University of Alabama at Birmingham, Birmingham, AL; Center for Infectious Disease Research in Zambia, Lusaka, Zambia. wcarlo@peds.uab.edu; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
    OBJECTIVE: To determine if early developmental intervention (EDI) improves developmental abilities in resuscitated children. STUDY DESIGN: This was a parallel group, randomized controlled trial of infants unresponsive to stimulation who received bag and mask ventilation as part of their resuscitation at birth and infants who did not require any resuscitation born in rural communities in India, Pakistan, and Zambia. Intervention infants received a parent-implemented EDI delivered with home visits by parent trainers every other week for 3 years starting the first month after birth. Parents in both intervention and control groups received health and safety counseling during home visits on the same schedule. The main outcome measure was the Mental Development Index (MDI) of the Bayley Scales of Infant Development, 2nd edition, assessed at 36 months by evaluators unaware of treatment group and resuscitation history. RESULTS: MDI was higher in the EDI (102.6 ± 9.8) compared with the control resuscitated children (98.0 ± 14.6, 1-sided P = .0202), but there was no difference between groups in the nonresuscitated children (100.1 ± 10.7 vs 97.7 ± 10.4, P = .1392). The Psychomotor Development Index was higher in the EDI group for both the resuscitated (P = .0430) and nonresuscitated children (P = .0164). CONCLUSIONS: This trial of home-based, parent provided EDI in children resuscitated at birth provides evidence of treatment benefits on cognitive and psychomotor outcomes. MDI and Psychomotor Development Index scores of both nonresuscitated and resuscitated infants were within normal range, independent of early intervention.