OpenUCT :: Browsing by Author "Molteno, Christopher D"

Browsing by Author "Molteno, Christopher D"

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Open Access
Aggressive behavior in adolescents with fetal alcohol spectrum disorders
(2013) Smith, Keelie; Jacobson, Sandra W; Molteno, Christopher D
Behavioral studies of fetal alcohol spectrum disorders (FASD) have indicated that aggression is common amongst alcohol-exposed adolescents, and that it appears to become more prevalent with age in that population. Such studies have documented the presence of aggression as a behavioral outcome, but have not provided detailed information regarding its presentation, including whether it is proactive or reactive in nature and under which circumstances it arises. Consequently, there is a lack of a theoretical framework within which to understand aggression in FASD. The current research comprised two studies. In Study 1, comorbid developmental disorders that are typically associated with aggression were examined in alcohol-exposed and non-exposed boys and girls. The results indicated a higher prevalence of disruptive behavior disorders, and conduct disorder in particular, amongst the alcohol-exposed boys, and highlighted a significant association between prenatal alcohol exposure and an aggressive subtype of conduct disorder. Based on these findings, Study 2, a multiple-case study, examined the aggressive behaviors of 6 alcohol-exposed and nonexposed adolescents and their classmates.
Open Access
A cross cultural study of motor development in the Western Cape
(1986) Irwin-Carruthers, Sheena Margaret Hamilton; Molteno, Christopher D
Despite conflicting evidence regarding advanced motor behaviour in black African infants, very few comparative studies have been published. Reliable developmental norms for local populations are essential for the early identification of developmental disabilities. In this study the sample consisted of 681 black and 741 white infants drawn proportionally from the Child Health Care Clinics in the northern areas of greater Cape Town. Babies were sampled in specified age-intervals between the ages of 16 and 1170 days. Variables studied were sex, birth-ranking, weight-percentile at the time of testing, marital status of the mother, parents' education and occupation, family size and family income. The demographic characteristics of the sample were compared with those of the population as a whole, based upon the 1980 census. The testing instruments were the gross and fine motor-adaptive sections of the Denver Developmental Screening Test, supplemented by another 21 items representing reflex reactions or specific components of movement. These supplementary items were pre-tested for inter- and intra-observer reliability. The percentage of children responding to the different tests at different ages was determined by probit analysis or, where more appropriate, by non-parametric logistic regression. Differences between the black and white South African infants were subjected to further statistical analysis, as was the contribution of the different variables to the attainment age. Comparison of the performance of the South African infants with the Denver norms showed that both black and white babies were in advance of the Denver children on the majority of fine motor items. The black infants were also considerably advanced in gross motor behaviour; the white infants less markedly so. In the very few (3) items in which the Denver children excelled, doubts exist regarding either scoring criteria or cultural suitability. Comparative analysis of the two South African samples identified certain consistent developmental trends. The black infants performed better on basic grasping patterns whereas the white infants were advanced in manipulative skills. The black infants were advanced on gross motor behaviour in the first year but were overtaken by the white group on learned gross motor skills in the second and third year, with the exception of items requiring physical strength. Very little correlation could be shown between motor achievement and socio- economic factors. Differences appear to be largely due to child-handling practices and experiential learning, but ethnic characteristics may well play a role in the advanced early gross motor development of the black infant. Heavier infants also performed better in both groups, indicating nutritional influences. The clinical implications of the findings are discussed and recommendations made for implementation and for further research.
Open Access
Development and validation of a quantitative choline food frequency questionnaire for use with drinking and non-drinking pregnant women in Cape Town, South Africa
(BioMed Central, 2018-11-22) Carter, R Colin; Jacobson, Sandra W; Booley, Sharmilah; Najaar, Baheya; Dodge, Neil C; Bechard, Lori J; Meintjes, Ernesta M; Molteno, Christopher D; Duggan, Christopher P; Jacobson, Joseph L; Senekal, Marjanne
Background Although animal and human studies have demonstrated interactions between dietary choline and fetal alcohol spectrum disorders, dietary choline deficiency in pregnancy is common in the US and worldwide. We sought to develop and validate a quantitative food frequency questionnaire (QFFQ) to estimate usual daily choline intake in pregnant mothers. Methods A panel of nutrition experts developed a Choline-QFFQ food item list, including sources with high choline content and the most commonly consumed choline-containing foods in the target population. A data base for choline content of each item was compiled. For reliability and validity testing in a prospective longitudinal cohort, 123 heavy drinking Cape Coloured pregnant women and 83 abstaining/light-drinking controls were recruited at their first antenatal clinic visit. At 3 prenatal study visits, each gravida was interviewed about alcohol, smoking, and drug use, and administered a 24-hour recall interview and the Choline-QFFQ. Results Across all visits and assessments, > 78% of heavy drinkers and controls reported choline intake below the Dietary Reference Intakes adequate intake level (450 mg/day). Women reported a decrease in choline intake over time on the QFFQ. Reliability of the QFFQ across visits was good-to-acceptable for 2 of 4 group-level tests and 4 of 5 individual-level tests for both drinkers and controls. When compared with 24-hr recall data, validity of the QFFQ was good-to-acceptable for 3 of 4 individual-level tests and 3 of 5 group-level tests. For controls, validity was good-to-acceptable for all 4 individual-level tests and all 5 group-level tests. Conclusions To our knowledge, this is the first quantitative choline food frequency screening questionnaire to be developed and validated for use with both heavy and non-drinking pregnant women and the first to be used in the Cape Coloured community in South Africa. Given the high prevalence of inadequate choline intake and the growing evidence that maternal choline supplementation can mitigate some of the adverse effects of prenatal alcohol exposure, this tool may be useful for both research and future clinical outreach programs.
Open Access
The development of posture in very low birthweight infants (<1500 grams)
(1993) Magasiner, Vivien Adele; Molteno, Christopher D; Malan, A
The aims of the study were to examine postural development in very low birthweight and normal birthweight infants and to determine whether deviant postures were predictive of adverse neurodevelopmental outcome. In the first part of the study the 7 postural responses selected by Vojta to evaluate neuromotor development were applied to 69 very low birthweight (VLBW < 1 500 grams) infants and to 28 healthy full-term infants of normal birthweight (> 2500 grams). Of the 69 VLBW infants, 43 were small for gestational age and 26 appropriate for gestational age. All infants were examined at term and 4 months corrected age. They were all later assessed on the Griffiths Mental Development Scale at 12 and 18 months corrected age. There were significant differences in postural reactions between the 2 groups which confirmed the lower tone and greater extension previously described in VLBW infants. An important finding in the study was that poor head and trunk righting noted at 4 months corrected age in VLBW infants, was associated with less developed locomotion at 12 and 18 months as assessed by the Griffiths Mental Development Scale. Thus, a delay in maturation in VLBW infants which was apparent from the assessment of postural responses was still identifiable on the locomotor sub-scales at 12 and 18 months. Five of Vojta's responses were shown to be useful as part of the neurological assessment of high risk infants. In the second part of the study, the 5 useful Vojta responses were incorporated into the Infant Neurodevelopmental Assessment (INA) which was used to assess 76 high risk VLBW infants. The 76 infants consisted of 34 infants with intracranial lesions on ultrasound and 42 without intracranial lesions. All infants were assessed at term and 4 % months corrected age using the INA. At 12 months corrected age they were all assessed on the Griffiths Mental Development Scale. Six infants were diagnosed as having cerebral palsy, all of whom had intracranial lesions. Several clinical signs indicative of cerebral palsy were significant at 4 % months corrected age and will be useful in future studies to diagnose cerebral palsy early. The association between lack of head and trunk control at 4 % months corrected age and a lower locomotor score at 12 months corrected age proved to be significant again and reinforces the finding that early delay in maturation is identifiable on the locomotor scale at 12 months corrected age.
Open Access
Event-based prospective memory in fetal alcohol spectrum disorders
(2013) O'Leary, Catherine; Thomas, Kevin; Jacobson, Sandra; Molteno, Christopher D
Learning and memory seem to be particularly vulnerable to the effects of heavy prenatal alcohol exposure. Previous research has, however, been limited to the study of retrospective memory (i.e., episodic or declarative memory) in children with a history of prenatal alcohol exposure. Recently, memory researchers have turned their attention to the study of prospective memory (PM), or the ability to realize and act on delayed intentions, in clinical populations. There are no published studies exploring PM in FASD, however. Prospective remembering is reliant on declarative memory as well as intact executive functioning, both of which are known to be impaired in FASD. The current study aimed, therefore, to investigate event-based PM functioning in a longitudinal cohort of children with heavy prenatal alcohol exposure. It also aimed to investigate whether the relation between prenatal alcohol exposure and prospective memory was influenced by IQ, executive functioning, or retrospective memory.
Open Access
Neurodevelopmental outcome of the high risk infant in Cape Town
(2000) Thompson,Mary Clare; Molteno, Christopher D
The outcome of high risk infants provides an important audit of neonatal care. This audit renders valuable information to clinicians, parents and health care planners. Available outcome data from the developing world are sparse and urgently needed. This work was compiled with three aims in mind: to provide data from Cape Town on outcome of high risk infants (including both infants of very low birthweight and infants who have survived hypoxic ischaemic encephalopathy); to evaluate selected early neurodevelopmental assessments of these infants; and to propose a protocol for their effective follow-up. Three separate cohorts were selected and studied in order to achieve these aims. A prospective six-year follow-up study of infants with birth weights less than 1250 g was undertaken at Groote Schuur Hospital's Neonatal Intensive Care Unit. The aim of the study was to document the morbidity, mortality and neurodevelopmental outcome of these infants. Of 235 liveborn infants, 143 (61 %) survived to discharge. Better survival was documented for infants who weighed more than 900 g and were over 30 weeks gestation and whose mothers attended antenatal care. One hundred and six infants (83% of survivors) underwent clinical assessment at one year of age and were evaluated with the Griffiths Scales of Mental Development. Ninety six (91 %) of these survivors were seen and tested at two years of age and 80 (76%) were seen at six years of age together with 70 matched controls who had normal birthweights. Of the 106 infants assessed at one year of age, six infants were diagnosed as cerebral palsied, six were globally developmentally delayed without signs of cerebral palsy and one infant showed significant motor delay with a normal developmental quotient. At two years of age one further infant had cerebral palsy and nine more infants were developmentally delayed. At six years of age five infants had cerebral palsy, one was intellectually disabled and three were intellectually borderline. The major disability rate at one year of age was 11%, at two years of age was 22% and at six years of age was eight percent. The incidence of low birthweight children with possible learning disability was three times that of their matched controls and overall, the low birthweight children scored significantly less in all developmental measures. Forty-five infants who developed hypoxic ischaemic encephalopathy after birth were studied prospectively. A numeric scoring system for the assessment of hypoxic ischaemic encephalopathy during the neonatal period which had previously been developed at Groote Schuur Hospital was tested. The value of the score in predicting neurodevelopmental outcome at one year of age was assessed. Thirty five infants were evaluated at 12 months of age by full neurological examination and the Griffiths Scales of Mental Development. Five infants were assessed at an earlier stage, 4 who died before 6 months of age and one infant who was hospitalised at the time of the 12-month assessment. Twenty three (58%) of the infants were normal, 17 (42%) were abnormal, 16 with cerebral palsy and one with developmental delay. 25 infants were re-evaluated at 3 years of age. 15 of these 25 had been normal at one year of age and were evaluated with ten controls who had had an uneventful perinatal course. The Hypoxic lschaemic Encephalopathy Score was highly predictive for outcome. The best correlation with outcome was a combination of the peak score and evaluation on day seven; giving a positive predictive value of 92% and a negative predictive value of 100% for abnormal outcome, with a sensitivity of 100% and specificity of 93%. At three years of age the HIE survivors without cerebral palsy scored as well as their matched controls on Griffiths developmental evaluation. In these normal survivors no correlation between severity of HIE and developmental quotient was demonstrated. Infants with neurodevelopmental abnormality need to start therapy early and because of this, should be detected as soon as possible. Currently, no widely accepted method of early evaluation exists. A Perinatal Risk Rating, the Dubowitz Neurological Assessment and the Infant Neuromotor Assessment were compared in terms of predicting neurodevelopmental outcome at one year of age. A cohort of 130 consecutive neonatal intensive care unit graduates were selected according to high risk criteria. Each infant was examined at term gestational age on the Dubowitz Neurological Assessment and a Perinatal Risk Rating was allocated. The study infants were seen again at 18 weeks corrected age, when an Infant Neuromotor Assessment was done, and at one year of age the Griffiths Scales of Mental Developmental and full neurological examination were carried out. Of the 130 infants assessed at term, all were seen at 18 weeks. Thereafter five were lost to follow-up and two died. The outcome of all the remaining 123 infants is known. Prediction of a normal outcome at 1 year of age on the Dubowitz Neurological Assessment was 96% and for the Perinatal Risk Rating, 98%, but for an abnormal outcome they predicted only 56% and 42% respectively. The Infant Neurological Assessment at 18 weeks of age predicted a normal outcome at one year in 99% and an abnormal outcome in 82%. Very low birthweight infants are at higher risk for cerebral palsy and intellectual disability. In Groote Schuur Hospital, at six years of age, the major disability rate for infants with birthweights less than 1250 g was eight percent. Forty percent of term infants who survived hypoxic ischaemic encephalopathy had cerebral palsy with associated intellectual disability. The use of the Perinatal Risk Rating is appropriate in newborn facilities where cranial ultrasound is available. Otherwise the Dubowitz Neurological Assessment is an appropriate screening tool in the newborn period. Use of the Hypoxic Ischaemic Encephalopathy Score is recommended for clinical evaluation, prognostication and risk rating. It is proposed that high risk infants should be evaluated at 18 weeks corrected age with the Infant Neuromotor Assessment at a tertiary centre. If this assessment is normal, the infant can then be discharged to community clinic follow-up. Infants with more than one deviant sign at this age need continued review and those with more than three signs should be referred for neurodevelopmental therapy to a comprehensive neurodevelopmental clinic. Even those high-risk infants whose assessments are normal should be enrolled in a pre-school centre at five years of age to facilitate detection of learning problems prior to school entry.
Open Access
The prevalence of neural tube defects and the outcome of myelomeningocele in Cape Town
(1996) Buccimazza, Sandro Sabatino; Molteno, Christopher D
This study was designed to document the prevalence of neural tube defects in Cape Town and to determine the outcome of children born with a myelomeningocele and operated on within the Neurosurgical service of the University of Cape Town. The aim of the prevalence study was to document the frequency of neural tube defects (NTD) over a twenty year period in Cape Town (1973 - 1992) and to determine the effects of race, gender, maternal age, parity, and season of conception on the prevalence. Multiple sources of ascertainment were used, including all maternity hospital records, neurosurgical and spinal defects clinic data, as well as those from the Human Genetics Department and Fetal Abnormality Group. The prevalence rates for NTD fluctuated between 1,74 and 0,63 per 1 000 births, but showed no significant trends over the twenty year period. Prevalence rates were highest for the white population group at 2,56 per 1 000 births compared to 0,95 per 1 000 for blacks and 1,05 per 1 000 for those of mixed ancestry. The higher rates in the whites, who are of British and European extraction and belong to the more affiuent section of the community, would suggest that the possible effects of nutrition and infection are overshadowed by genetic factors. There was a female preponderance for both spina bifida (M:F ratio 0,89) and anencephaly (M:F ratio 0,67). The highest NTD rates were found at both ends of the maternal age range (<20 years and >35 years of age). The prevalence was highest at the extremes of birth order (1,65 and 1,58 for birth order 1 and >7, respectively, and 0,56 and 0,45 for birth order 5 and 6, respectively). A seasonal variation occurred which differed from that reported for the Northern Hemisphere and may reflect local climatic conditions. The aim of the outcome study was to follow a group of infants who were operated on for myelomeningocele (01 January 1979 - 31 December 1985) and evaluate their outcome at five years of age, in an attempt to identify factors that may influence the quality of survival and their outcome, and to utilise these findings to recommend altering and improving ( where possible) the management of children born with myelomeningocele.
Open Access
The relationship between growth, development and social milieu - a longitudinal study involving preschool Coloured children in Cape Town
(1986) Molteno, Christopher D; Bowie, Malcolm David
A prospective longitudinal study was carried out to establish the relationship between growth, development and social milieu in Coloured pre-school children in Cape Town. This population was selected because, on the basis of previous studies, a wide range of nutritional status as well as a spectrum of socio-economic conditions were known to exist. A pilot study was conducted to establish the feasibility of obtaining information about factors to be included in the study as well as to determine the most suitable sampling methods. A cohort of 1 000 consecutive Coloured infants born in the Cape Town municipal area and notified to the Cape Town City Council was identified. A random sample of 187 was selected from the cohort for long-term study. Anthropometric data were documented from birth until 5 years and compared to the NCHS reference values. Developmental data consisted of milestones recorded during infancy, language assessment on the Reynell Language Scale at 2½ years carried out by the Logopaedics Department, University of Cape Town, and at 5 years, a specially constructed developmental assessment designed to assess gross motor function, fine motor development including visuo-motor skills and language, both comprehension and expression as well as basic colour and number concepts. Social data were collected during home visits by two experienced, full-time research social workers, who were both integrally involved in the planning of the study. At birth infants were relatively light and short for gestational age. Size at birth correlated with social class. A rapid post-natal weight gain rendered them relatively overweight between 3 and 6 months. Thereafter they again became lighter and shorter than the NCHS reference values and this persisted during the pre-school period. Mother's weight was related to weight at birth, 12 months and 30 months. The genetic influence on growth was reflected in a correlation between parental height and child's length from 12 months onwards. Environmental influences as assessed by social class by occupational grading of the breadwinner, income and family stability were also correlated with growth from 12 months onwards. Infant development as indicated by milestones was very similar to internationally reported studies. Motor development was not associated with social class by occupational grading of the breadwinner but with father's education, mother's personality and family stability. It was also highly correlated with growth during infancy. Early language milestones were associated with the child's micro-environment as indicated by marital status, family unit, setting and stability. Language development at 30 months reflected a general lag in verbal skills and was correlated with parental education and family stability. At five years there was a good correlation between growth, development and social milieu, although the social variables accounted for far more of the variation in development than did growth. Social class by occupation grading of the breadwinner and income reflected the general socio-economic status and there was a good cross-correlation between the social variables. Approximately one third of the families lived in a middle cl ass environment. However, poor maternal education, low incomes and over-crowding were prevalent and must constitute risk factors in child rearing. Sixty five percent of the mothers were not educated further than primary school level and over half of the families were living below an effective minimum level of income. Similarly, over half the families lived in grossly overcrowded conditions. In conclusion, therefore, during infancy developmental milestones were similar to those reported in the literature. Later, however, there was a fall-off in development and this coincided with a greater association with social circumstances. Just prior to school entry social factors far outweighed growth indices as predictors of developmental variation. Social stability of the family a composite evaluation based on a number of social characteristics, was most consistently associated with development. The implications for intervention are that this would need to be broad based and aimed at improving incomes, housing, family cohesion and child centredness and eliminating social pathology. Such intervention would require a concerted effort from a variety of sources which should include administrators, community workers and health professionals.
Open Access
Visual perception and motor function of children with birth-weights under 1250grams and their full term normal birth weight peers at five to six years of age : a Cape Town study
(1996) Coetzer, Dorothea; Molteno, Christopher D
This study aimed to assess and compare the visual perceptual, visual motor integration and motor abilities of infants weighing less than 1250 grams at birth and a matched group of normal full birth weight controls at the age of five to six years. The group of infants with birth weights below 1250 grams were born during the period July 1988 to June 1989 at Groote Schuur Hospital (GSH), Cape Town or in midwife obstetric units in the Peninsula Maternal and Neonatal Service (PMNS) and referred to the neonatal intensive care unit at GSH. The very low birth weight (VLBW) infants were assessed at 1 and 2 years of age in 1989 & 1990. The present study was part of a broader study that included the examination of developmental outcome of these infants, using the Griffith's Mental Development Scale (Griffith's). The study recognised the complex interaction of biological and environmental factors and their influence on development and attempted to describe the confounds that may have influenced outcomes. The VLBW children were shorter in stature than their full birth weight counterparts. They were also significantly lighter and had smaller head circumferences. Psychometric evaluation with the Griffith's showed the VLBW children to fall predominantly in the normal range, though their performances were significantly inferior to that of the full-term children. The greatest differences between the groups were in scores for the subscales performance and practical reasoning of the Griffith's. Visual perception, visual motor integration, fine motor skill and gross motor function were all significantly poorer in the VLBW children. There was no correlation within the VLBW group between the test results and birth weight, gestational age, growth status, neonatal hospital stay or social status.

Browsing by Author "Molteno, Christopher D"

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