Emerging developmental sequelae in the 'normal' extremely low birth weight infant.

Thirty-six extremely low birth weight (less than 1000 g birth weight) children received neurodevelopmental testing in infancy (mean age = 19.1 months), and again in early childhood (mean age = 46.5 months). Children were categorized into a high-risk group (n = 20) if bronchopulmonary dysplasia and/or Grades III or IV intracranial hemorrhage were present or a low-risk group (n = 16) if neither were present. Using standardized testing and neuromotor examination, 24 (67%) of 36 children showed normal infant development. Only 11 (31%) of 36 children (P less than .005) had normal development upon reassessment in early childhood. A decline in developmental status occurred in both groups. This indicates that for the extremely low birth weight population, normal infant development is poorly predictive of continued normal development. With or without major complications, extremely low birth weight places children at substantial risk for ongoing and emerging developmental problems with age.     

Is it correct to correct? Developmental milestones in 555 "normal" preterm infants compared with term infants

To determine whether correction for preterm birth should be applied during developmental assessment, we conducted a prospective national survey of very premature infants (born at less than 32 weeks of gestation); neurodevelopment in the first 2 years was studied with the Dutch child health care developmental assessment. In 555 preterm children who had no evidence of handicap at 2 years of age, the age at which developmental milestones were reached was established. The results were compared with the results of the same assessment in Dutch children born at term. During the first year, the development of the very premature children equaled the development of normal children when full correction was applied. At 2 years of age, development was equal to or better than normal children's development without correction. We conclude that full correction for prematurity should be applied in the first year to avoid overreferral for developmental stimulation, whereas at 2 years of age correction is not necessary.     

Preschool performance of children with normal intelligence who were very low-birth-weight infants

Children who were very low-birth-weight infants (less than 1,500 g), beneficiaries of modern neonatal intensive care, are now of school age. To evaluate their school performance 80 children born in 1976 who had very low-birth-weight (mean birth weight 1.2 kg, mean gestational age 30 weeks) were examined at age 5 years. Sixty-five children were neurologically intact and had normal IQ (greater than or equal to 85) on the Stanford-Binet; five children were neurologically abnormal and ten had IQ below 85. Of the 65 children with normal intelligence and no neurologic impairments, 46 were single births and enrolled in preschool. These 46 children were matched by race, sex, and family background with classmate control children who had been born at full term. Outcome measurements included the Slosson Intelligence Test, the Woodcock-Johnson Psycho-Educational Battery (including subscales of Picture Vocabulary, Spatial Relations, Memory for Sentences, Visual Auditory Learning, Quantitative Concepts, and Blending) and the Beery Developmental Test of Visual-Motor Integration. No significant differences in IQ were found between children who were very low-birth-weight infants and control children; however, children who were very low-birth-weight infants performed significantly less well on the Spatial Relations subtest of the Woodcock-Johnson and on the Visual-Motor Integration test. Similar results were found for nine sets of twins and their control children. Recognition of these perceptual and visual-motor problems may permit appropriate early remedial intervention and prevent the compounding of these difficulties.     

Behavioural and emotional problems in very preterm and very low birthweight infants at age 5 years

BACKGROUND: Children born very preterm (VP; <32 weeks' gestation) or with very low birth weight (VLBW, <1500 g; hereafter called VP/VLBW) are at risk for behavioural and emotional problems during school age and adolescence. At school entrance these problems may hamper academic functioning, but evidence on their occurrence at this age in VP/VLBW children is lacking. AIM: To provide information on academic functioning of VP/VLBW children and to examine the association of behavioural and emotional problems with other developmental problems assessed by paediatricians. Design, SETTING AND PARTICIPANTS: A cohort of 431 VP/VLBW children aged 5 years (response rate 76.1%) was compared with two large national samples of children of the same age (n = 6007, response rate 86.9%). OUTCOME MEASURES: Behavioural and emotional problems measured by the Child Behavior Checklist (CBCL), and paediatrician assessment of other developmental domains among VP/VLBW children. RESULTS: The prevalence rate of a CBCL total problems score in the clinical range was higher among VP/VLBW children than among children of the same age from the general population (13.2% v 8.7%, odds ratio 1.60 (95% confidence interval 1.18 to 2.17)). Mean differences were largest for social and attention problems. Moreover, they were larger in children with paediatrician-diagnosed developmental problems at 5 years, and somewhat larger in children with severe perinatal problems. CONCLUSION: At school entrance, VP/VLBW children are more likely to have behavioural and emotional problems that are detrimental for academic functioning. Targeted and timely help is needed to support them and their parents in overcoming these problems and in enabling them to be socially successful.     

Neurodevelopmental and school performance of very low-birth-weight infants: a seven-year longitudinal study

The changing patterns of neurologic and developmental functioning between 1 and 7 years of age were studied in very low-birth-weight infants (birth weight less than or equal to 1,500 g). Subjects included 42 infants born in 1975 who were followed for 7 years. Based on the 1-year neurologic assessment, 22 infants were classified as normal, 12 as suspect, and eight as abnormal. The three groups did not differ in birth weight, gestational age, sex, or Hollingshead socioeconomic status (SES) score. The neurologic findings at 7 years of age were significantly related to the neurologic examination findings at 1 year of age. Seventy-seven percent of the normal group, 58% of the suspect group, and 100% of the abnormal group remained in the same neurologic category at 7 years of age. Children in the abnormal group had the greatest improvement in cognitive functioning between 1 and 7 years of age but did not achieve the IQ level of children in the normal group. Forty-five percent of the normal group, 75% of the suspect group, and 100% of the abnormal group had poor visual-motor integration. Fifty-eight percent of the suspect group and 87% of the abnormal group were reading below age level. Of the total sample, 54% required special education or resource help at 7 years of age, and the three groups differed significantly in their need for a special educational plan (P less than .05). These data indicate that a neurologic classification at 1 year of age provides a guide for monitoring very low-birth-weight infants and can be helpful in alerting school personnel to potential needs.     

Developmental data in preschool children born after prolonged pregnancy

Aim: To evaluate children born post-term (gestational age ≥42 weeks) with respect to developmental data obtained at the ages of 4 and 5.5 y. Methods: The study population included all children (n=354) born in 1991 at Huddinge University Hospital with a gestational age of ≥42 wk. The births were identified and perinatal data were collected through the Swedish National Birth Registry. Developmental assessments from the child health centres were analysed. Children born at term, but before a gestational age of 42 wk, served as controls. Logistic regression analysis was used to analyse the data. Results: Children born post-term had more developmental deviations than the controls (estimated odds ratio 2.20; 95% CI: 1.29-3.85). Boys had more deviations than girls (estimated odds ratio 1.92; 95% CI: 1.11-3.45).

Conclusion: Our results indicate that there might be an association between post-term birth and developmental deviations.     

Parents' evaluation of developmental status in children born with a birthweight of 1250 g or less

OBJECTIVE: To evaluate the agreement between parental reporting of development of children born very preterm using the Parents' Evaluation of Developmental Status (PEDS) questionnaire and professional assessment by a paediatric developmental team in the detection of sensorineural disability. METHODS: A cross-sectional cohort study of 362 children born in Queensland with a birthweight < or = 1250 g, who were surviving at 2 and 4 years of age corrected for prematurity, was conducted. Parents completed the PEDS questionnaire prior to their child receiving a neurodevelopmental assessment. The level of agreement for sensorineural disability between the neurodevelopmental assessment and the parents' score on the PEDS questionnaire was measured using the kappa statistic, and screening test characteristics were calculated. Logistic regression was used to investigate factors that might affect agreement. RESULTS: Two hundred and eighty-three (78%) of the eligible children were located and contacted. Of these, 216 (76%) agreed to participate in the study (110, 2-year-olds; 106, 4-year-olds). Agreement between the two forms of rating sensorineural disability (developmental quotient > -2SD (standard deviation), cerebral palsy, bilateral blindness and deafness requiring aids) for the 4-year age group children was fair (kappa = 0.27, P = 0.001). PEDS accurately identified 69% (11 of 16) of disabled children and 72% (65 of 90) non-disabled children. The test characteristics for these children were similar to Glascoe's norming sample with a PPV 31% (95% CI: 14-48%), specificity 72% (95% CI: 62-81%), but lower sensitivity 69% (95% CI: 62-81%) and higher false-negative rate 31% (95% CI: 11, 59). Agreement for the 2-year age group was fair with poor test characteristics. Other comparisons for both age groups (PEDS A and B compared using a disability status with DQ > -1SD) showed poor agreement and test characteristics. Gestation age < 27 weeks and maternal education at or below grade 10 in the 2-year age group were the only factors independently affecting agreement. CONCLUSIONS: The agreement between parental evaluation of sensorineural disability status using PEDS and paediatrics developmental assessment in children born very preterm at 4-years corrected age for prematurity compares favourably with Glascoe's norming sample. The lower agreement seen in the 2-year age group limits the utility of PEDS to be used as a screen for disability at an age when early intervention may be useful. The PEDS questionnaire is designed and normed for the general paediatric population, and it is not clear if parents of children born very preterm may have interpreted the PEDS questionnaire in relation to their satisfaction with their child's developmental progress rather than their child's functional ability.     

Effect of salt supplementation of newborn premature infants on neurodevelopmental outcome at 10-13 years of age

BACKGROUND: The nutritional requirements of prematurely born infants are different from those of babies born at term. Inadequate or inappropriate dietary intake in the neonatal period may have long term adverse consequences on neurodevelopmental function. The late effect of neonatal sodium deficiency or repletion in the premature human infant on neurological development and function has not been examined, despite evidence in animals of a serious adverse effect of salt deprivation on growth of the central nervous system. METHODS: Thirty seven of 46 children who had been born prematurely (gestational age of 33 weeks or less) and allocated to diets containing 1-1.5 mmol sodium/day (unsupplemented) or 4-5 mmol sodium/day (supplemented) from the 4th to the 14th postnatal day were recalled at the age of 10-13 years. Detailed studies of neurodevelopmental performance were made, including motor function and assessment of intelligence (IQ), memory and learning, language and executive skills, and behaviour. Sixteen of the children were found to have been in the supplemented group and 21 in the unsupplemented group. RESULTS: Children who had been in the supplemented group performed better in all modalities tested than those from the unsupplemented group. The differences were statistically significant (analysis of variance) for motor function, performance IQ, the general memory index, and behaviour as assessed by the children's parents. The supplemented children outperformed the unsupplemented controls by 10% in all three components of the memory and learning tests (difference not significant but p < 0.1 for each) and in language function (p < 0.05 for object naming) and educational attainment (p < 0.05 for arithmetic age). CONCLUSION: Infants born at or before 33 weeks gestation require a higher sodium intake in the first two weeks of postnatal life than those born at or near term, and failure to provide such an intake (4-5 mmol/day) may predispose to poor neurodevelopmental outcome in the second decade of life.     

Comparison of abilities of preterm and maturely born children at 5 years of age

This study investigated whether the development of 5 year old preterm born children was appropriate for age and equivalent to or different from their peers who were full term at birth. At the adjusted age of 5 years, the development of 106 children born 5 or more weeks before term was compared with the development of 103 children who were born at term. This latter group of children were matched to the preterm group in sex, year of birth, birthplace, race and residential location. No cerebral palsy children were included in either subject group. The results indicated a significant difference between the two groups. Factors distinguishing the preterm children from their full term peers included small involuntary hand movements, less competent gross motor ability, poorer verbal performance and more variability in behaviour, postural response and balance. A higher than average incidence of minor motor, speech, behaviour and learning problems in early school years is probable.     

Improvement of developmental outcome between 24 and 36 months corrected age in very preterm infants

Aim: To study early developmental course in preschool‐aged very preterm infants and its association with perinatal risk factors and test‐taking behaviour. Methods: Children born <30 weeks gestation and/or <1000 g in the Academic Medical Center of Amsterdam were assessed at 24 and 36 months corrected age with the Dutch Bayley Scales of Infant Development‐II (BSID‐II‐NL) and neurological examination. Linear regression analyses for developmental change were performed with perinatal risk factors. Results: One hundred and forty‐six children, mean GA 28 weeks and mean birth weight 1043 g, participated. Mental and psychomotor scores improved significantly with 6 and 7 points, respectively, from 24 to 36 months (p < 0.01). Mild to severe problems on at least one domain occurred less often at 36 (32%) compared to 24 months (63%) (p < 0.01), using corrected scores. Mental improvement was associated with being born very small for gestational age or <28 weeks; psychomotor improvement was associated with not being treated with indomethacin. Difficult test behaviour occurred mostly at 24 months and was associated with non‐optimal development at 36 months. Conclusion: Improved developmental outcome and test behaviour were found at 36 compared to 24 months in a cohort of very preterm children. Long‐term outcome studies and retesting of behaviourally difficult children are recommended.     

Comparison of abilities of preterm and maturely born children at 5 years of age

This study investigated whether the development of 5 year old preterm born children was appropriate for age and equivalent to or different from their peers who were full term at birth.
At the adjusted age of 5 years, the development of 106 children born 5 or more weeks before term was compared with the development of 103 children who were born at term. This latter group of children were matched to the preterm group in sex, year of birth, birthplace, race and residential location. No cerebral palsy children were included in either subject group.
The results indicated a significant difference between the two groups. Factors distinguishing the preterm children from their full term peers included small involuntary hand movements, less competent gross motor ability, poorer verbal performance and more variability in behaviour, postural response and balance. A higher than average incidence of minor motor, speech, behaviour and learning problems in early school years is probable.     

Social–emotional delays at 2 years in extremely low gestational age survivors: Correlates of impaired orientation/engagement and emotional regulation

Background

Premature infants are less socially and emotionally competent at school age than infants born at term.

Aims

To evaluate the correlates of social and emotional delays at 2 years of age among prematurely born children.

Study design

This is a prospective cohort study.

Subjects

904 children born at < 28 weeks gestation during 2002–2004 and enrolled in the ELGAN study who survived until age 2 years and returned for a developmental assessment.

Outcome measures

The Bayley Behavior Rating Scale (BRS), a neurological examination, and the Bayley Scales of Infant Development II (BSID-II).

Results

Fully 31% of children had a non-optimal (14%) or questionable (17%) (NO/Q) BRS score for Emotional Regulation (ER), and 27% had a non-optimal (13%) or questionable (14%) score for Orientation/Engagement (O/E). Children with NO/Q scores on ER and O/E were more likely than others to have MDI and PDI scores < 70 and be unable to walk. Antecedents of NO/Q OE scores included multi-fetal pregnancy, while antecedents of NO/Q scores for both ER and O/E included indicators of socioeconomic disadvantage, and male sex.

Conclusions

Over 25% of children born extremely premature exhibit socio-emotional delays during developmental assessment at age 2 years. Antecedents of these delays include sociodemographic characteristics, as well as those common antecedents of other impairments commonly observed among extremely preterm infants.     

The complexity of feeding problems in 700 infants and young children presenting to a tertiary care institution

BACKGROUND: Feeding problems are common in infants and young children. A multidisciplinary team approach contributes to better patient care. However, few quantitative data on multidisciplinary feeding assessment of children have been published.OBJECTIVES The first aim of this study was to characterize the etiology of feeding difficulties in 700 children referred for assessment of severe feeding difficulty. The authors differentiated medical, oral, and behavioral categories. The second aim was to assess the prevalence of prematurity and dysmaturity in the patients and their relationship to the type of feeding problem. METHODS: Clinical data from 700 children aged less than 10 years who were examined for severe feeding problems were analyzed. RESULTS: Close to 50% of the children had a combined medical and oral condition underlying their feeding difficulties. More than half of the children were examined for gastrointestinal conditions, particularly gastroesophageal reflux disease. Behavioral problems were more frequently seen in children aged more than 2 years. The results indicate that oral sensory-based feeding problems are related to past medical intervention. Children with feeding disorders had a significantly lower birthweight for gestational age. Preterm babies were overrepresented in this population. CONCLUSIONS: A multidisciplinary team approach is essential for assessment and management because combined medical and oral problems are the most frequent cause of pediatric feeding problems. A significant relationship was found between the type of feeding problem and age. Infants born preterm and/or with a birthweight below the tenth percentile for gestational age are at greater risk for developing feeding disorders.     

Prognosis of perinatal brain damage: a prospective study of a one year birth cohort of 12,000 children

The prognosis of perinatal brain damage was studied prospectively in a one year birth cohort of 12,000 children born in Northern Finland in 1966. Children were included in the study if they had an Apgar score of 0 at 1 min or less than 5 at 15 min, convulsions during the neonatal period, or a diagnosis of asphyxia, brain injury or intraventricular haemorrhage, but did not have CNS malformation, chromosomal aberrations or hereditary CNS degeneration. There were 233 children, 19.3 per thousand, of which 134, 58.0% were boys. Eighty-four, 36.4% died during the first 28 days and 7 children died before the age of 14 years, 6 of the latter group being handicapped. There were 44 children, 29.9% who had mental retardation, IQ less than 71, epilepsy or cerebral palsy. With regard to these children 13 had normal school performance, but there were 12 other children in the perinatal brain damage group who needed special education, two of them because of deafness. Perinatal brain damage accounted for 57.5% of all neonatal deaths, 30% of admissions to a special nursery and 12.5% of mental retardation (IQ less than 71), epilepsy and cerebral palsy at the age of 14.     

Die neurologische und kognitive Entwicklung zu klein geborener Kinder

This article aims to provide an overview on the neurological and cognitive outcome of children who were “born too small”. We will discuss the neurodevelopmental prognosis of term born small for gestational age children, and for children born prematurely (appropriate and small for gestational age). The various underlying causes responsible for intrauterine growth retardation (IUGR) and significance for neurodevelopmental outcome will be discussed briefly. Neurodevelopmental outcome of term born children with IUGR due to intrauterine malnutrition and outcome of preterm born small for gestational age (SGA) as well as preterm born appropriate for gestational age (AGA) children will then be discussed in more detail. Children with IUGR represent a heterogeneous group regarding the underlying cause that is responsible for the growth retardation. Neurodevelopmental prognosis very much depends on the specific underlying cause. IUGR caused by intrauterine malnutrition is not necessarily associated with neurodevelopmental problems. However, results of several studies suggest that in term born children with IUGR mild neuromotor problems and lower full scale IQ is more frequent when compared with term born appropriate for gestational age children. Prematurely born children are at high risk for neurodevelopmental impairment. There is no difference in frequency of disabling impairments between AGA and SGA preterm children. However, in preterms with IUGR there seems to be a higher frequency of mild neuromotor problems and cognitive function seems to be poorer than in appropriate for gestational age preterms.     

Emotion self-regulation in preschool-aged children with and without orofacial clefts

Emotion self-regulation is an important developmental task in the preschool period that is related to children's emotional and behavioral adjustment in early childhood. Emotion self-regulation and its relation to later adjustment has not been studied in children born with orofacial clefts, despite their risk for externalizing and internalizing behavior problems. Eighty-three 5-year-old children with cleft lip and palate, isolated cleft palate, or no cleft condition were videotaped during a laboratory disappointment situation. Results showed that children in the cleft group expressed less disappointment than children in the comparison group. Longitudinal analyses revealed that parenting stress measured when the children were 2 years of age predicted Expressed Disappointment at age 5 years, which, in turn, predicted severity of behavior problems at age 7 years. Although tentative, results indicate that control over mild negative affect may be a protective factor for children with clefts, buffering the effects of early stress on the development of later behavioral and emotional problems. Thus, interventions that reduce parenting stress and enhance children's emotion regulation strategies may decrease the risk for later psychological problems in this population.     

体外受精受孕婴儿12月龄时精神运动发育状况

目的探讨辅助生殖技术受孕与自然受孕婴儿在12月龄精神运动发育水平有无差异。方法采用配对对照研究方法,将辅助生殖技术受孕婴儿(实验组)与自然受孕婴儿(对照组)在母亲年龄、产次、社会阶层、父母受教育程度等几方面严格配对后,自母亲孕28周起入组登记,定期随访,收集相关资料,至婴儿12月龄采用中国儿童发展中心(CDCC)婴幼儿发育量表行精神运动发育评估。结果实验组早产、低出生体质量、双胎妊娠率明显高于对照组,但二组12月龄智力发育指数(MDI)及运动发育指数(PDI)无显著差异。结论辅助受孕婴儿12月龄精神运动发育水平正常。但这一特殊人群因为高发的多胎妊娠、早产、低出生体质量等因素,其健康及以后的生长发育仍需长期随访跟踪。     

Hyperinflation in premature infants at preschool age

Functional residual capacity was measured by helium gas dilution in 12 children born very preterm (gestational age 25-29 weeks). The children were studied at between 4.0 and 4.6 years of age. Their results were compared to those of 12 control children who were born at term without neonatal problems. The controls were matched to the children born preterm for age, race and gender. The children born preterm had significantly increased functional residual capacity values when compared to the control subjects (p less than 0.01). Eight children born preterm were hyperinflated (functional residual capacity greater than 120% of that predicted for height) compared to only one control subject (p less than 0.01). Five children born preterm and one control had a positive response to bronchodilator administration. These results suggest infants born very preterm may suffer from chronic hyperinflation.     

Preschool outcome in children born very prematurely and cared for according to the Newborn Individualized Developmental Care and Assessment Program (NIDCAP)

Aim: Care based on the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) has been reported to exert a positive impact on the development of prematurely born infants. The aim of the present investigation was to determine the effect of such care on the development at preschool age of children born with a gestational age of less than 32 wk. Methods: All surviving infants in a randomised controlled trial with infants born at a postmenstrual age less than 32 wk (11 in the NIDCAP group and 15 in the control group) were examined at 66.3 (6.0) mo corrected for prematurity [mean (SD)]. In the assessment we employed the Wechsler Preschool and Primary Scale of Intelligence-Revised (WPPSI-R) for cognition, Movement Assessment Battery for Children (Movement ABC) for motor function, subtests of the NEPSY test battery for attention and distractibility, and the WHO definitions of impairment, disability and handicap. Exact binary logistic regression was employed. Results: There were no significant differences between the intervention group in Full-Scale IQ 93.4 (14.2) [mean (SD)] versus the control group 89.6 (27.2), Verbal IQ 93.6 (16.4) versus 93.7 (26.8) or Performance IQ 94.3 (14.7) versus 86.3 (24.8). In the NIDCAP group 8/13 (62%) survived without disability and for the children with conventional care this ratio was 7/19 (37%). The corresponding ratios for surviving without mental retardation were 10/13 (77%) and 11/19 (58%), and for surviving without attention deficits 10/13 (77%) and 10/19 (53%). Overall, the differences were not statistically significant, although the odds ratio for surviving with normal behaviour was statistical significant after correcting for group imbalances in gestational age, gender, growth retardation and educational level of the parents.

Conclusion: Our trial suggests a positive impact by NIDCAP on behaviour at preschool age in a sample of infants born very prematurely. However, due to problems of recruitment less than half of the anticipated subjects were included in the study, which implies a low power and calls for caution in interpreting our findings. Larger trials in different cultural contexts are warranted.     

Movement and motor development in ELBW infants at 1 year is related to cognitive and motor abilities at 4 years

A relationship between motor ability and cognitive performance has been previously reported. This study aimed to investigate the association between movement and cognitive performance at 1 and 4 years corrected age of children born less than 1000 g, and whether developmental testing of movement at 1 year is predictive of cognitive performance at 4 years. Motor development was assessed at both ages using the neurosensory motor developmental assessment (NSMDA) and motor development was classified as normal, or minimal, mild, moderate-severe dysfunction. Cognitive performance was assessed on the Griffith Mental Developmental Scale at 1 year and McCarthy Scales of Children's Abilities at 4 years. Subjects included 198 children of birthweight less than 1000 g. Of these 132 children returned for follow-up at the corrected ages of both 1 and 4 years. The 66 children not included had a slight increase in gestational age, while the mothers were younger and had a lower level of education. A significant association was found between NSMDA group classification at 1 year and cognitive performance at both 1 and 4 years (p<0.001; p<0.0001) and between the subscales of each test (1 year, p<0.0001; 4 years, p<0.001). Group classification of motor development at 1 year was predictive of cognitive performance at 4 years (p<0.0001) and this was independent of biological and social factors and presence of cerebral palsy (CP). The findings support a close link between motor and cognitive development in children born <1000 g and emphasise the advantage of detailed assessment of movement at 1 year.