Project Details

Assessment of the impact of gestational xylitol exposure on early neurodevelopmental outcomes of infants

Sara Neches, MD, FAAP

Summary

BACKGROUND: 95% of children living with moderate or severe neurodevelopmental delay (NDD) live in low- and middle-income countries (LMICs). Maternal periodontal disease is a risk factor for preterm birth (PTB) and also increases fetal exposure to inflammation, both independent risk factors for NDD. Xylitol, a sugar alcohol found in certain chewing gum products, reduces PTB and has anti-inflammatory properties, potentially preventing NDD in gestationally exposed children. GAP: No study has evaluated gestational xylitol exposure on early neurodevelopmental outcomes. As limitations in neurodevelopmental examiners with doctorate-level training exist in LMICs, studies are needed to explore the feasibility of employing community health workers (CHWs) to administer neurodevelopmental assessments in LMICs. HYPOTHESIS: Gestational xylitol use will improve infant neurodevelopmental outcomes at 6 and 18 months corrected gestational age (CGA). Intensively trained CHWs will have >90% concurrence with a gold-standard pediatric neurologist. METHODS: We will perform a prospective follow-up study of pediatric subjects (25 xylitol-exposed and 25 xylitol-unexposed children) who were gestationally exposed to xylitol or placebo chewing gum. All children will undergo evaluation with the Hammersmith Infant Neurological Exam (HINE), Developmental Assessment of Young Children (DAYC-2), and the Malawi Development Assessment Tool (MDAT) at 6 and 18 months CGA by a CHW and pediatric neurologist. RESULTS: Pending. IMPACT: Xylitol, an affordable, simple, accessible intervention, has the potential to prevent NDD among Malawian children. Increasing the pool of individuals capable of performing neurodevelopmental assessments can lead to improved outcomes for children residing in LMICs through early detection, referral, and treatment of children with NDD.