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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Neurodevelopmental retardation, as assessed clinically and with magnetoencephalography and electroencephalography,
G W Ten Tusscher1, M M Leijs2, L C C de Boer1
1Department of Paediatrics and Neonatology, Westfriesgasthuis, Maelsonstraat 3, 1624 NP Hoorn, Netherlands.
Insights
High perinatal dioxin exposure in 1980s Western Europe was linked to behavioral issues in children. Neurophysiological tests revealed subtle brain development effects, suggesting standard tests are less sensitive to chemical exposures.
Area of Science:
- Environmental Health
- Neuroscience
- Developmental Pediatrics
Background:
- 1980s Western Europe experienced high background levels of dioxin exposure in humans.
- Perinatal exposure to environmental chemicals can impact neurodevelopment.
- Assessing neurodevelopmental effects of background chemical exposure is crucial.
Purpose of the Study:
- To evaluate the neurodevelopment of children exposed perinatally to dioxins during prepubertal and adolescent periods.
- To investigate the association between dioxin/dioxin-like PCBs (dl-PCBs) and neurodevelopmental outcomes.
- To compare the sensitivity of neurophysiological tests versus standard clinical tests.
Main Methods:
- Cohort study involving 41 children (7-12 years) and 33 adolescents (14-18 years).
- Neurodevelopmental assessment included neuromotor (Touwen's test), psychological (WISC-R, CBCL, TRF), and neurophysiological (MEG, EEG) tests.
- Serum dioxin and dl-PCB levels were measured in adolescence.
Main Results:
- No association between perinatal dioxin exposure and IQ or neuromotor development in prepubertal children.
- Behavioral problems were linked to both prenatal and postnatal dioxin exposure.
- Adolescents showed problems associated with current dioxin/dl-PCB levels.
- Neurophysiological tests revealed negative dysfunction: increased latency (13 ms) and decreased amplitude (12%) in response to stimuli, indicative of defective myelination and neuronal loss.
Conclusions:
- Perinatal dioxin exposure affects behavior, and current levels impact adolescents.
- Neurophysiological testing effectively detects subtle brain development effects from background chemical exposure in healthy children.
- Standard clinical, neurological, and psychological tests lack sensitivity for detecting these effects.
Unlabelled:
In 1980s Western Europe, human perinatal exposure to background levels of dioxins was rather high. We therefore evaluated the neurodevelopment of our cohort during the prepubertal period and in adolescence. At prepubertal age (7-12 years) 41 children were tested. Both neuromotor functioning and psychological testing were performed (Dutch version of the Wechsler Intelligence Scale for Children (WISC-R) and the Dutch version of the Child Behavior Checklist for ages 4-18 years (CBCL 4-18) and the Teacher Report Form (TRF)). Neurophysiological tests were performed using magnetoencephalography and electroencephalography. In adolescence (14-18 years) the behavior of 33 children was studied again (CBCL and TRF). And the levels of dioxins and dioxin-like PCBs (dl-PCBs) were measured in serum.
Results:
At prepubertal age no association was found between perinatal dioxin exposure and verbal, performal and total IQ or with the Touwen's test for neuromotor development. There were behavioral problems associated with both prenatal and postnatal dioxin exposure. In adolescence there were problems associated with the current dioxin levels and dioxin-like-PCBs. Neurophysiological tests revealed clear negative dysfunction. An increase in latency time after a motion stimulus (N2b) of 13 ms (= a delay of 10%) is associated with the higher prenatal dioxin exposure. A similar delay was measured in testing cognitive ability by analyzing the odd ball measurements, N200 and P300, together with an amplitude decrease of 12 %. The delay is indicative of a defective myelinisation and the decrease in amplitude of a loss of neurons.
Conclusion:
We found effects on behavior in association with the perinatal dioxin exposure and in adolescence in association with the current dioxin levels. Neurophysiological testing is instrumental in the detection of effects of perinatal background levels of chemicals on brain development in normal, healthy children. The clinical, neurological and psychological tests commonly used are not sensitive enough to detect important effects.
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