Neurocognitive and Motor Functions in Biliary Atresia Patients: A Cross-sectional, Prospective National Cohort Study.

OBJECTIVES: The aim of the study was to evaluate the neurocognitive and motor development of biliary atresia (BA) patients in childhood and adolescence and to identify risk factors for impaired outcome. METHODS: We invited all BA patients between ages 1 and 20 years followed up at Helsinki University Children's Hospital in Finland between 1 January 2019 to 31 January 2020 to participate. All participants underwent age-appropriate validated neurocognitive tests. Participants between 3.0 and 16.9 years of age were assessed with the Movement Assessment Battery for children, version 2. Guardians of participants between ages 5 and 17 years filled the Five-to-Fifteen-Revised (5-15R) parental questionnaire. RESULTS: The mean (±standard deviation [SD]) total intelligence quotient (IQ) of the 39 participants was 91 ±â€Š15, lower compared with test norms (mean IQ 100 ±â€Š15, P < 0.01). Earlier clearance of jaundice (COJ) had a positive effect on mean (±SD) total IQ (COJ <3 months 96 ±â€Š13 vs COJ ≥3 months post-portoenterostomy 84 ±â€Š13, P < 0.05). Out of 30 participants assessed, 13 (43%) were either at risk or fulfilled the criteria for impaired motor development. Guardians reported elevated rates of functional difficulties affecting everyday life. There were no significant differences between native liver and liver transplanted (16/41%) groups. CONCLUSIONS: IQ is moderately, and motor scores markedly impaired in BA patients compared with normative data. Standardised cognitive and motor assessment before school-age for all BA patients is advisable to identify individuals in need of additional support.

Neonatal Intestinal Failure Is Independently Associated With Impaired Cognitive Development Later in Childhood.

OBJECTIVE: The impact of pediatric intestinal failure (IF) on neurodevelopment beyond infancy has not been systematically studied. Our aim was to evaluate cognitive and motor impairment and to identify risk factors for adverse outcomes among children with IF. METHODS: We conducted a cross-sectional single-center study at the Helsinki University Children's Hospital. Patients with IF with >60 days of parental nutrition (PN) dependency aged between 3 and 16 years (n = 40) were invited to participate. The cognitive and motor skills were evaluated using validated tests: Wechsler Preschool and Primary Scale of Intelligence, 3rd edition, Wechsler Intelligence Scale for Children, 4th edition, and Movement Assessment Battery for Children, 2nd edition. RESULTS: All the patients attending the study tests (n = 30, males = 24) were included. Their median age, gestational age, and birth weight was 7.5 (range 3-16) years, 35 (interquartile range [IQR] 28-38) weeks and 2238 (IQR 1040-3288) grams, respectively. Median duration of PN was 13 (IQR 5-37) months and 9 patients were currently on PN. Median intelligence quotient was 78 (IQR 65-91) and 10 (35%) patients had an intelligence quotient under 70 (-2 standard deviation). Significant motor impairment was detected in 10 patients (36%) and milder difficulties in 8 (28%). Adverse cognitive outcome was associated with neonatal short bowel syndrome, number of interventions under general anesthesia, and length of inpatient status, whereas adverse motor outcome was associated with prematurity. CONCLUSION: Clinically significant cognitive and motor impairments are alarmingly common among neonatal patients with IF. We recommend early neurodevelopmental follow-up for all children with IF.

Game-based situation awareness training for child and adult cyclists.

Safe cycling requires situation awareness (SA), which is the basis for recognizing and anticipating hazards. Children have poorer SA than adults, which may put them at risk. This study investigates whether cyclists' SA can be trained with a video-based learning game. The effect of executive working memory on SA was also studied. Thirty-six children (9-10 years) and 22 adults (21-48 years) played the game. The game had 30 video clips filmed from a cyclist's perspective. Each clip was suddenly masked and two or three locations were presented. The player's task was to choose locations with a potential hazard and feedback was given for their answers. Working memory capacity (WMC) was tested with a counting span task. Children's and adults' performance improved while playing the game, which suggests that playing the game trains SA. Adults performed better than children, and they also glanced at hazards more while the video was playing. Children expectedly had a lower WMC than adults, but WMC did not predict performance within the groups. This indicates that SA does not depend on WMC when passively viewing videos.

Training counting skills and working memory in preschool.

Previous studies have shown that early numeracy skills predict later mathematics learning and that they can be improved by training. Cognitive abilities, especially working memory (WM), play an important role in early numeracy, as well. Several studies have shown that working memory is related to early numeracy. So far, existing literature offers a good few examples of studies in which WM training has led to improvements in early numerical performance as well. In this study, we aim at investigating the effects of two different training conditions: (1) counting training; and (2) simultaneous training of WM and counting on five- to six-year-old preschoolers' (N = 61) counting skills. The results show that domain-specific training in mathematical skills is more effective in improving early numerical performance than WM and counting training combined. Based on our results, preschool-aged children do not seem to benefit from short period group training of WM skills. However, because of several intervening factors, one should not conclude that young children's WM training is ineffectual. Instead, future studies should be conducted to further investigate the issue.