title: The Use of Cardiac Orienting Responses as an Early and Scalable Biomarker of Alcohol-Related Neurodevelopmental Impairment.
abstract: Considered the leading cause of developmental disabilities worldwide, fetal alcohol spectrum disorders (FASD) are a global health problem. To take advantage of neural plasticity, early identification of affected infants is critical. The cardiac orienting response (COR) has been shown to be sensitive to the effects of prenatal alcohol exposure and is an inexpensive, easy to administer assessment tool. The purpose of this study was to evaluate the COR effectiveness in assessing individual risk of developmental delay.
  
  
  
  As part of an ongoing longitudinal cohort study in Ukraine, live-born infants of women with some to heavy amounts of alcohol consumption in pregnancy were recruited and compared to infants of women who consumed low or no alcohol. At 6 and 12 months, infants were evaluated with the Bayley Scales of Infant Development-II. CORs were also collected during a habituation/dishabituation learning paradigm. Using a supervised logistic regression classifier, we compared the predictive utility of the COR indices to that of the 6-month Bayley scores for identification of developmental delay based on 12-month Bayley scores. Heart rate collected at each second (Standard COR) was compared to key features (Key COR) extracted from the response.
  
  
  
  Negative predictive values (NPV) were 85% for Standard COR, 82% for Key COR, and 77% for the Bayley, and positive predictive values (PPV) were 66% for Standard COR, 62% for Key COR, and 43% for the Bayley.
  
  
  
  Predictive analysis based on the COR resulted in better NPV and PPV than the 6-month Bayley score. As the resources required to obtain a Bayley score are substantially more than in a COR-based paradigm, the findings are suggestive of its utility as an early scalable screening tool based on the COR. Further work is needed to test its long-term predictive accuracy.
authors.affiliation: Department of Bioengineering, University of California, San Diego, La Jolla, California.
authors.forename: Diego A
authors.identifier: 0000-0002-2251-688X
authors.initials: DA
authors.lastname: Mesa
authors.affiliation: Department of Psychiatry and Behavioral Science, Emory University School of Medicine, Atlanta, Georgia.|Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Kable
authors.affiliation: Department of Psychiatry and Behavioral Science, Emory University School of Medicine, Atlanta, Georgia.|Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Claire D
authors.initials: CD
authors.lastname: Coles
authors.affiliation: Department of Pediatrics, University of California, San Diego, La Jolla, California.
authors.forename: Kenneth Lyons
authors.initials: KL
authors.lastname: Jones
authors.affiliation: OMNI-Net for Children International Charitable Fund, Rivne Regional Medical Diagnostic Center, Rivne, Ukraine.
authors.forename: Lyubov
authors.initials: L
authors.lastname: Yevtushok
authors.affiliation: OMNI-Net for Children International Charitable Fund, Rivne Regional Medical Diagnostic Center, Rivne, Ukraine.
authors.forename: Yaroslav
authors.initials: Y
authors.lastname: Kulikovsky
authors.affiliation: Department of Pediatrics, University of California, San Diego, La Jolla, California.|Department of Medical Genetics, University of South Alabama, Mobile, Alabama, California.
authors.forename: Wladimir
authors.initials: W
authors.lastname: Wertelecki
authors.affiliation: Department of Bioengineering, University of California, San Diego, La Jolla, California.
authors.forename: Todd P
authors.initials: TP
authors.lastname: Coleman
authors.affiliation: Department of Pediatrics, University of California, San Diego, La Jolla, California.|Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California.
authors.forename: Christina D
authors.initials: CD
authors.lastname: Chambers
mesh_terms: D000161:Acoustic Stimulation / Q000379:methods; D000328:Adult; D000428:Alcohol Drinking / Q000009:adverse effects / Q000453:epidemiology / Q000503:physiopathology*; D015331:Cohort Studies; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D008137:Longitudinal Studies; D008297:Male; D065886:Neurodevelopmental Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology*; D010775:Photic Stimulation / Q000379:methods; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology*; D014455:Ukraine / Q000453:epidemiology; D055815:Young Adult
keywords: Alcohol; Cardiac Orienting; Fetal Alcohol Spectrum Disorders; Pregnancy; Prenatal Alcohol