Predictive value of early motor evaluation in preterm very low birth weight and term small for gestational age children

Background

Motor problems are common in children born preterm or small for gestational age.

Aim

To study the predictive value of early motor assessments for later motor skills.

Subjects

Twenty-eight children born preterm with very low birth weight (VLBW: birth weight ≤ 1500 g), 57 children born small for gestational age (SGA: birth weight < 10th centile) at term and 77 term-born controls with normal birth weight.

Methods

The psychomotor development index (PDI) of the Bayley Scales of Infant Development was used as a measure of motor skills at age one, the Peabody Developmental Motor Scales (PDMS) at age five and the Movement Assessment Battery for Children (Movement ABC) at age 14. Low/borderline low scores were defined as < − 2SD/− 1SD (PDI) or < 5th/15th centile (PDMS; Movement ABC).

Results

In the VLBW group, motor problems in adolescence were identified both by low PDI (sensitivity: 0.80; 95%CI:0.38-0.96) and PDMS scores (sensitivity: 0.83; 95%CI:0.44-0.97). In the SGA and the control group sensitivity was poor for low PDI and moderate for low PDMS scores. However, in the SGA group, sensitivity increased when borderline low PDMS scores were used as cut-off (sensitivity: 0.75; 95%CI:0.41-0.93). Specificity of PDI and PDMS was high in all three groups.

Conclusions

Both PDI and PDMS may be valuable tools for early identification of motor problems in VLBW children, whereas PDMS best predicted motor problems in the two other groups. In all three groups, a normal motor examination at 1 and 5 years was highly predictive of normal motor skills at age 14.     

A comparison of prematurity and small for gestational age as risk factors for age 6-13year emotional problems

Background

Although both very preterm (VP) and small for gestational age (SGA) births are suggested to increase the likelihood of childhood emotional problems, there has been a lack of research comparing these effects.

Aims

To investigate levels of emotional problems between 6–13 years of age and contrast the impact of being born either very premature (irrespective of birth weight) or small for gestational age.

Study design

Prospective longitudinal cohort study.

Subjects

654 Bavarian children (born 1985–1986) who were followed from birth to age 12/13 years.

Outcome measures

Emotional problems at ages 6.3 and 8.5 years were measured via the Child Behavior Check List (CBCL). Emotional problems were measured at age 12/13 years via the Strengths and Difficulties Questionnaire (SDQ). Trajectories of emotional problems were derived between 6.3 and 13 years.

Results

Two distinctive patterns of age 6–13 year emotional problems were found: 1) a low and stable level of problems in 76% of children; 2) a high and stable level of problems in 24% of children. The high and stable pattern of emotional problems was significantly associated with a VP but not an SGA birth. Consistent additional determinants included male child gender and lower family socioeconomic status.

Conclusions

The disparity between VP and SGA births as a predictor of age 6–13 year old emotional problems is considered in terms of fetal and/or glucocorticoid programming. The stability of emotional problems between 6 and 13 years reinforces the need for early childhood interventions aimed at children born very preterm.     

Change in cognitive abilities over time during preschool age in low risk preterm children

Background

More information is needed on ‘low-risk’ preterm infants' neurological outcome so that they can be included in follow-up programs at least until school age.

Objective

To examine the neuropsychological outcome in a group of low-risk low birth weight (LBW) children without neurological impairment followed from birth to 5 years of age.

Patients

26 intellectually normal children born preterm (30–34 weeks gestation) without major neurological disabilities and 23 control children born at term and matched for age, sex, and parental educational and occupational status.

Methods

Subjects already evaluated at 3 years of age underwent assessment again at 5 years using as neuropsychological outcome measures a wide range of tests including perceptual and visual–motor function, language comprehension and expression, and attention skills.

Results

When tested at 5 years, children born preterm still obtained significantly lower mean scores than controls on visual motor integration test (57 vs 64, p = 0.01), visual perception test (41 vs 43, p = 0.002) and a trend toward a lower score in the picture vocabulary test (81 vs 85.5, p = 0.07). The group of premature infants and controls improved their performance over time in the neuropsychological abilities investigated and, in some skills such as visual perception. Children born preterm took longer than those born at term to reach similar performance levels, 5 versus 3 years.

Conclusion

Ex low-risk children born preterm achieve lower scores over time in visual–motor and perceptual ability scales and in some language tests than children born at term. Like high-risk premature infants even those at low risk deserve regular follow-up with long-term programs.     

Cerebral and mesenteric tissue oxygenation by positional changes in very low birth weight premature infants

Aim

There has been no clear consensus of the appropriate positioning in preterm infants. We aimed to evaluate the changes of cerebral and mesenteric tissue oxygenation in three different positions, by near infrared spectroscopy (NIRS), in stable very low birth weight (VLBW) infants of postnatal > 30 days.

Methods

NIRS monitoring of cerebral and mesenteric tissue oxygenation in three different positions was performed in 29 stable preterm newborns in neonatal intensive care unit (NICU). The patients were observed in three different positions consecutively, each lasting for 4 h. The demographic features, cerebral and mesenteric tissue oxygenation with positional changes and feeding periods were recorded.

Results

Mean gestational age, mean birth weight and mean postnatal age of the patients were 27.6 ± 1.7 weeks, 1046 ± 308 g and 42.4 ± 15.7 days, respectively. There were no statistically significant differences in cerebral and mesenteric tissue regional SO₂ values in each position (p = 0.954 and p = 0.151, respectively). The values of cerebral and mesenteric tissue regional SO₂ before and after feeding did not show any statistically significant difference in each position.

Conclusions

Clinically stable very low birth weight infants are able to maintain a stable cerebral and mesenteric tissue oxygenation in different positions, both before and after feeding. Positional changes seem to be safe in VLBW stable infants and this influence should be considered in care of these patients in the NICU.Clinical Trials Identification Number: NCT01255189.     

Factors associated with rehospitalizations of very low birthweight infants: impact of a transition home support and education program

Objective

To determine the effects of a transition-home education and support program, BPD, and health insurance type on VLBW infant rehospitalizations at 3 and 7 months corrected age. It was hypothesized that the transition-home program would be associated with decreased rehospitalizations between Phase 1 and 2, and public health insurance and BPD would be associated with increased rehospitalizations.

Methods

274 infants with birth weight < 1500 g were enrolled in two successive years of a transition-home program (Phase 1—start-up) and (Phase 2—full implementation) and followed to 7 months CA.

Results

The Phase 2 rehospitalization rates were lower but not statistically significant at both 3 months (20% and 15%; p = 0.246), and 7 months (24% and 17%; p = 0.171). Infants with public insurance had twice as many rehospitalizations by 3 months (28% versus 11%; p = 0.018) in Phase 1. In regression analyses the intervention effects did not achieve significance for the cohort at 3 months (OR = 0.63; CI = 0.33 to 1.20) or 7 months (OR = 0.61; CI = 0.33 to 1.13). BPD and public insurance did not reach significance in the models whereas siblings were significantly associated with increased odds of rehospitalization. In subgroup analyses for infants on pubic health insurance the intervention significantly decreased the odds of rehospitalization between Phase 1 and 2(OR = 0.43; CI = 0.19 to 0.96) at 3 months.

Conclusions

Our findings suggest that a transition-home program may be beneficial to reduce the rehospitalization rate for VLBW infants, and infants on public insurance may derive greater benefit.     

Inter- and intra-modal matching in very low birth weight and small for gestational age adolescents

Background

Motor problems in low birth weight children may be related to problems in sensorimotor integration processes. Specific tests of inter- and intra-modal matching have not been used in low birth weight populations.

Aim

Examine whether low birth weight adolescents have poorer performance in inter- and intra-modal matching than normal birth weight adolescents.

Study design

A population based follow up study of very low birth weight and small for gestational age children at 14 years of age.

Subjects

Fifty-three very low birth weight adolescents (VLBW: birth weight ≤ 1500 g), 59 term small for gestational age (SGA: birth weight < 10th centile) and 82 adolescents with birth weight ≥ 10th centile at term (reference group).

Outcome measures

Inter- and intra-modal matching was assessed by a manual matching task and results were presented for the preferred and the non-preferred hand in the visual (inter-modal) and proprioceptive (intra-modal) condition.

Results

VLBW adolescents performed poorer in inter- and intra-modal matching compared with the reference group. However, the results were mainly due to a higher number of adolescents with cerebral palsy (CP) and a low estimated intelligence quotient (IQ_est) in the VLBW group. SGA adolescents showed poorer performance with their non-preferred hand compared with their preferred hand in both inter- and intra-modal matching, whereas adolescents in the reference group and VLBW adolescents with normal IQ_est and without CP performed equally well with both hands.

Conclusion

VLBW adolescents with normal IQ_est and without CP do not have major problems in inter- and intra-modal matching. The poorer performance with the non-preferred hand in the SGA group may suggest a specific effect of intrauterine growth retardation.     

The Stockholm Neonatal Family-Centered Care Study: effects on salivary cortisol in infants and their mothers

Background

Parental involvement in the care of preterm infants in neonatal intensive care units (NICUs) is common, but little is known about the effect on stress responses in mothers and infants.

Aims

The aim of this study is to evaluate the effect of family-centered care on salivary cortisol reactivity in mothers and preterm infants and the correlation between the mothers' and the preterm infants' salivary cortisol levels.

Methods

This study is part of a randomized controlled trial conducted at two level-II NICUs, including Family Care (FC), where parents were able to stay 24 h/day from admission to discharge, and Standard Care (SC). To investigate the cortisol response, saliva was collected from 289 preterm infants and their mothers before and after a diaper change at the time of discharge.

Results

No significant differences were found between the two groups in salivary cortisol reactivity, either in mothers or in infants. The results revealed a correlation between preterm infants' and their mothers' baseline and response cortisol in the FC group: r = 0.31 (p = 0.001) and r = 0.24 (p = 0.01), respectively. Such correlation was not observed in the SC group: r = 0.14 (p = 0.14) and r = 0.18 (p = 0.07), respectively.

Conclusions

Family-centered care had no effect on salivary cortisol reactivity during diaper change. However, sharing the same environment may increase the concordance between preterm infants' and their mothers' salivary cortisol levels.     

Entorhinal cortical thinning affects perceptual and cognitive functions in adolescents born preterm with very low birth weight (VLBW)

Background

The entorhinal cortex serves as an important gateway between the cerebral cortex and the hippocampus by receiving afferent information from limbic, modality sensory-specific, and multimodal association fibers from all the brain lobes.

Aim

To investigate whether thinning of entorhinal cortex is associated with reduced perceptual, cognitive and executive skills in very low birth weight (VLBW) adolescents.

Study design

Prospective, geographically based follow-up study of three year cohorts of preterm born VLBW children.

Subjects

Forty-nine VLBW (birth weight ≤ 1500 g) and 58 term-born control adolescents were examined at the age of 14–15 years.

Outcome measures

Perceptual and cognitive functions were assessed with Visual motor integration test, Grooved Pegboard test, Wechsler Intelligence Scale for Children-III and different executive function tests (Wisconsin card sorting test, Trail Making test, Knox cube test). An automated MRI technique at 1.5 T for morphometric analyses of cortical thickness was performed. Areas with cortical thinning in left and right entorhinal cortex in the VLBW group were chosen as regions of interest to look for associations between cortical thickness and clinical findings.

Results

Thinning of the entorhinal cortex was correlated with low performance on perceptual and cognitive scores in the VLBW adolescents, but not in controls. In addition, thinning of the entorhinal cortices correlated with reduced performance on several executive tests, including perceptual speed and aspects of working memory.

Conclusions

Entorhinal cortical thinning is related with low IQ and reduced perceptual and executive functions in VLBW adolescents.     

Oral and nonoral sensorimotor interventions facilitate suck-swallow-respiration functions and their coordination in preterm infants

Background

Preterm infants are at high risk of encountering oral feeding difficulties. Early sensorimotor interventions may improve oral feeding skills in preterm infants.

Aim

To further explore the effects of an oral (O), tactile/kinesthetic (T/K), and combined (O + T/K) sensorimotor intervention on preterm infants' nutritive sucking, swallowing and their coordination with respiration.

Study design

Seventy-five infants (29 [0.3, standard error of mean, SEM] weeks gestation, 49 males/26 females) were randomly assigned to an O group involving sensorimotor input to the oral structures; a T/K group involving sensorimotor input to the trunk and limbs; a combined (O + T/K) group; and a control group.

Outcome measures

Stage of sucking, suction and expression amplitudes (mm Hg), suck–swallow ratio, stability of suck–swallow interval, and swallow–respiration patterns.

Results

The O group had significantly more advanced sucking stages, and greater suction and expression amplitudes than controls [p ≤ 0.035, effect size (ES) > 0.6]. The suck–swallow ratio and stability of suck–swallow intervals did not significantly differ among groups (p ≥ 0.181, ES ≤ 0.3). The three interventions led to fewer swallows bracketed by prolonged respiratory pauses compared to controls (pause–swallow–pause, p ≤ 0.044, ES ≥ 0.7). The T/K and combined (O + T/K) groups had greater occurrence of swallows bracketed by expiration than the control and O groups (expiration–swallow–expiration, p ≤ 0.039, ES ≥ 0.3).

Conclusion

The O intervention enhanced specific components of nutritive sucking. All three interventions resulted in improved swallow–respiration coordination. Sensorimotor interventions have distributed beneficial effects that go beyond the specific target of input.     

Cortical thickness and cognition in very-low-birth-weight late teenagers

Background

Preterm born children with very low birth weight (VLBW: bw ≤ 1500 g) have an increased risk of perinatal brain injury which may influence the subsequent maturation of grey and white matter. Aberrant cortical development may have implications for future cognitive functioning.

Aims

The aim of this study was to measure deviations in cortical thickness and to investigate the relationship between cortical thickness, perinatal variables and IQ measurements in VLBW late teenagers compared with term-born controls.

Study design

Prospective follow-up study of three year cohorts of children from birth to early adulthood.

Subject

Forty-seven VLBW and 61 term born controls were examined at ages 18–21.

Outcome measures

Cognitive function was assessed with the WAIS-III, measuring full IQ and IQ indices. We applied an automated method to reconstruct the cortical surface based on T1-weighted MRI images using the FreeSurfer software.

Results

We found widespread areas of thinner cerebral cortex in the left parietal and temporal lobes and thicker cortex in frontal areas bilaterally in the VLBW group compared to controls. There were positive correlations between IQ and cortical thickness in areas in ventro-lateral frontal, parietal and temporal lobes in the VLBW group. The most pronounced cortical changes were seen in the VLBW subjects with the lowest birth weight and gestational age, and in those with IQ below 89.

Conclusion

Persistent cortical deviations seen in VLBW late teenagers are associated with immaturity at birth and level of cognitive functioning.     

Longitudinal growth of head circumference in term symmetric and asymmetric small for gestational age infants

Aims

To study longitudinal growth pattern of head circumference of full-term symmetric and asymmetric small for gestational age (SGA) infants of the two sexes during first year of life.

Study Design

Mixed-longitudinal growth research design.

Subjects

Head circumference amongst full-term 100 symmetric, 100 asymmetric as well as 100 appropriate for gestational age (AGA) infants was measured at birth, 1, 3, 6, 9 and 12 months of age using standardized technique and instrument.

Results

The mean head circumference of male symmetric SGA infants measured significantly (p ≤ 0.001) smaller than asymmetric SGA infants while, in female symmetric SGA infants it measured shorter beyond 6 months. As compared to AGA infants, head circumference in symmetric and asymmetric SGA infants measured significantly smaller in size. Growth velocity for head circumference amongst symmetric and asymmetric SGA male infants did not show statistically significant differences. Rate of head circumference growth remained significantly higher amongst female asymmetric SGA infants than the symmetric ones between 3 and 6 months while, a reversal of trend was observed between 9 and 12 months.

Conclusion

The better growth attainments for head circumference of male and female asymmetric SGA infants than their symmetric SGA counterparts during first postnatal year of life may be attributed to the continuation of influence of “head sparing” experienced by asymmetric SGA babies during prenatal life.     

The infant behavioral assessment and intervention program in very low birth weight infants; outcome on executive functioning, behaviour and cognition at preschool age

Background

The Infant Behavioral Assessment and Intervention Program (IBAIP©) improved motor function at 24 months, and mental and behavioural development in high risk subgroups of very low birth weight (VLBW) infants.

Aim

To determine IBAIP's effects on executive functioning, behaviour and cognition at preschool age.

Study design

Follow-up of a randomised controlled trial (RCT).

Subjects

At 44 months corrected age, all 176 VLBW infants were invited for follow-up. Forty-one term born children were assessed for comparison.

Outcome measures

Visual Attention Task (VAT), Gift delay, Peabody Picture Vocabulary Test III-NL (PPVT), Visual motor integration tests and Miller assessment for preschoolers. Parents completed Behavior Rating Inventory of Executive Function-Preschool (BRIEF-P) and Child Behavior Checklist (CBCL).

Results

At preschool age, 76 (88%) children of the intervention group and 75 (83%) children of the control group participated. There were no significant differences between the intervention and the control group. However, positive interaction effects between intervention and infants with bronchopulmonary dysplasia, infants born at gestational age < 28 weeks, and infants of low educated mothers were found on CBCL, CBCL and BRIEF-P, and PPVT respectively. Most interaction effects exceeded 1 standard deviation in favour of the intervention children. The 151 VLBW children performed significantly worse than the term born children on the VAT, BRIEF-P and CBCL.

Conclusion

IBAIP effects in VLBW children did not sustain until preschool age on executive functioning, behaviour and cognition. However, the most vulnerable children had a clinical relevant profit from IBAIP. VLBW children performed worse than the term born children.This study is a follow-up at preschool age of the multi-centre RCT of IBAIP versus usual care in VLBW infants. The RCT was performed in Amsterdam, The Netherlands (IBAIP RCT registered on http://www.controlled-trials.com number ISRCTN65503576).     

Motor skills at 23 years of age in young adults born preterm with very low birth weight

Background

Motor skills have previously not been reported in young adults born with very low birth weight (VLBW), although they are commonly reported in children and adolescents.

Aim

To compare fine and gross motor skills in VLBW young adults with matched term-born controls, and to study longitudinal changes in the VLBW group.

Study design

A geographically based follow-up study of a VLBW group and a control group.

Subjects

Thirty-six VLBW (birth weight ≤ 1500 g) young adults, including four participants with cerebral palsy (CP), and 37 matched controls (birth weight ≥ 10th centile) were examined at 14 and 23 years of age.

Outcome measures

Fine and gross motor skills were assessed using Grooved Pegboard test (GP), Trail Making Test-5 (TMT-5), Movement Assessment Battery for Children-2 (Movement ABC-2) and High-level Mobility Assessment Tool (HiMAT).

Results

VLBW young adults were slower than controls on GP (p = 0.026) and TMT-5 (p < 0.001). Mean total Movement ABC-2 score was 69.7 ± 20.2 in the VLBW group compared with 74.1 ± 14.4 in the control group (p = 0.017). Differences were also seen in manual dexterity and balance. Additionally, HiMAT showed reduced balance and speed in gross motor skills in the VLBW group. The proportion of participants with motor problems did not change between age 14 and 23. After exclusion of participants with CP, scores were essentially the same.

Conclusion

VLBW young adults had overall poorer fine and gross motor skills compared with controls. Reduced speed seemed to be an underlying problem. Longitudinal findings indicate that VLBW children have not outgrown their motor problems when entering adulthood.     

The metabolic effects of two different lipid emulsions used in parenterally fed premature infants--a randomized comparative study

Objective

To compare the effects of two different lipid emulsions, based on soybean oil and olive oil respectively on plasma lipid concentrations and acylcarnitine profile of very low birth weight infants.

Design

Randomized comparative study.

Patients and methods

Forty very low birth weight infants, ≤ 32 weeks of gestational age and receiving at least 40% of the calorie taken by parenteral nutrition from lipid solution at 14th day of life were evaluated. Group I (n = 20) received soybean oil based lipid emulsion (Intralipid®) and Group II (n = 20) received olive oil based lipid emulsion (Clinoleic®).

Main outcome measures

Plasma lipid concentrations and acylcarnitine profile were assessed.

Results

Triglyceride, cholesterol, high and low density lipoprotein levels, liver function tests were similar between two groups whereas very low density lipoprotein level was statistically lower in Group I (p < 0.05). Free carnitine levels were 15.73 ± 10.67 in Group I and 34.25 ± 22.18 μM in Group II (p = 0.012) and hexanoyl carnitine levels 2.18 ± 2.10 in Group I and 0.38 ± 0.12 μM in Group II, respectively (p = 0.005). Plasma medium chain acylcarnitine levels were significantly higher in Group I.

Conclusions

Low levels of very low density lipoprotein in Group I may be a way of hemostasis to keep the serum triglyceride within normal levels. Lower free carnitine levels in soybean oil-based group is the result of carnitine need during the mitochondrial transport of long chain fatty acids. In Group I, due to the inefficient transport of medium chain fatty acids into the mitochondria, medium chain acylcarnitines accumulate in plasma. This may be the reason of lower carnitine levels in Group I. We suggest that higher levels of hexanoyl carnitine, reflecting defective mitochondrial transport of hexanoyl which leads immunsupression, may be the cause of higher sepsis risk in Group I.     

Associations between maternal scaffolding and executive functioning in 3 and 4 year olds born very low birth weight and normal birth weight

Background

Deficits in executive function, including measures of working memory, inhibition and cognitive flexibility, have been documented in preschoolers born very low birth weight (VLBW) compared with preschoolers born normal birth weight (NBW). Maternal verbal scaffolding has been associated with positive outcomes for both at-risk and typically developing preschoolers.

Aims

The purpose of this study was to examine associations between maternal verbal scaffolding, Verbal IQ (VIQ) and executive function measures in preschoolers born VLBW.

Subjects

A total of 64 VLBW and 40 NBW preschoolers ranging in age from 3 ½ to 4 years participated in the study.

Outcome measures

VIQ was measured with the Wechsler Preschool and Primary Scale of Intelligence — Third Edition. Executive function tests included the Bear Dragon, Gift Delay Peek, Reverse Categorization and Dimensional Change Card Sort-Separated Dimensions.

Study design

Maternal verbal scaffolding was coded during a videotaped play session. Associations between maternal verbal scaffolding and preschoolers' measures of VIQ and executive function were compared. Covariates included test age, maternal education, and gender.

Results

Preschoolers born VLBW performed significantly worse on VIQ and all executive function measures compared to those born NBW. Maternal verbal scaffolding was associated with VIQ for VLBW preschoolers and Gift Delay Peek for the NBW group. Girls born VLBW outperformed boys born VLBW on VIQ and Bear Dragon.

Conclusion

Integrating scaffolding skills training as part of parent-focused intervention may be both feasible and valuable for early verbal reasoning and EF development.     

Cerebral palsy in children: Movements and postures during early infancy, dependent on preterm vs. full term birth

Background

A deviant motor behaviour at age 3 to 5 months is predictive of cerebral palsy (CP). Particular features of the early motor repertoire even proved predictive of the degree of functional limitations as classified on the Gross Motor Function Classification System (GMFCS) in children with CP, born preterm.

Aims

We aimed to determine whether an association between the early motor repertoire and the GMFCS also holds true for children born at term.

Study design

Longitudinal study.

Subjects

79 infants (60 boys and 19 girls; 47 infants born at term; video recorded for the assessment of movements and posture at age 9 to 20 weeks postterm age) who developed CP.

Outcome measures

The GMFCS was applied at age 2 to 5 years.

Results

Motor optimality at age 3 to 5 months showed a significant correlation with functional mobility and activity limitation as classified on the GMFCS at age 2 to 5 years in both children born at term (Spearman rho = − 0.66, p < 0.001) and born preterm (rho = − 0.37, p < 0.05). Infants born preterm were more likely to show normal movement patterns than infants born at term. A normal posture and an abnormal, jerky (yet not monotonous) movement character resulted in better levels of function and mobility. With the exception of one, none of the infants showed fidgety movements. A cramped-synchronised movement character, repetitive opening and closing of the mouth, and abnormal finger postures characterised children who would show a poor self-mobility later.

Conclusions

Assessing the quality of motor performance at 9 to 20 weeks postterm age (irrespective of the gestational age) improves our ability to predict later functional limitations in children with CP.     

Language outcomes and service provision of preschool children with congenital hearing loss

Background

Children with congenital hearing loss (HL) are at increased risk of speech and language delays and require increased resource needs.

Methods

Assessments of language, adaptive behavior, and resource needs at mean age of 60 ± 5 months. Effects of age of enrollment in Early Intervention (EI) and degree of HL were evaluated.

Results

Children with HL had lower Reynell verbal comprehension scores (77.6 ± 18 versus 94.8 ± 15; p = 0.0001) and expressive language scores (85.9 ± 19 versus 97.4 ± 15; p = 0.0051) than hearing children. Children with HL enrolled in EI ≤ 3 months versus > 3 months had higher verbal comprehension (86.6 ± 21 versus 70.3 ± 12; p = 0.0143) and expressive language scores (92.1 ± 12 versus 80.5 ± 21; p = 0.0601), respectively. Children with bilateral moderate to profound HL and children with unilateral or bilateral mild HL were more likely to have low verbal comprehension scores versus children with hearing (75.8 ± 17 and 81.0 ± 22 versus 94.8 ± 15; p = 0.001), and receive more special educational services (100% and 100% versus 42%) respectively. After adjusting for degree of HL and Vineland adaptive scores < 70, entry to EI ≤ 3 months was associated with a 13.8 point higher verbal comprehension score (p = 0.047) for children with HL. The model accounted for 26% of variance.

Conclusions

Persistent beneficial effects of early age of entry to EI on verbal comprehension scores are observed for children with congenital HL at preschool age. Children with HL continue to need comprehensive education services.     

Two-year neonatal outcome following PPROM prior to 25weeks with a prolonged period of oligohydramnios

Background

Improved neonatal survival data have been reported following early preterm prelabour rupture of membranes (PPROM) prior to 25 weeks gestation with a prolonged latency to delivery and persistent oligohydramnios. However, data regarding long-term respiratory and neurological morbidity are lacking.

Aims

To evaluate the respiratory and neurological outcome data at two years of age in a cohort of infants born following PPROM prior to 25 weeks with a prolonged latency (14 days) to delivery and compare the data to an aged matched group of infants.

Methods

Retrospective case note analysis over a 43-month period at Saint Luc University Hospital, Brussels.

Results

15 surviving infants born following PPROM were matched to a group of 30 control infants. Although there was no significant difference in the incidence of BPD between the groups (33% vs 27%, p = 0.24), the length of hospitalisation, duration of respiratory support and number of hospital readmissions for respiratory indications were all significantly higher for infants born following a prolonged period of oligohydramnios. There were no major anomalies on cranial ultrasound in the PPROM group and Baileys developmental assessment at 20–24 months corrected gestational age showed no difference between the two groups (Mental development index 93.9 vs 94.4 and Psychomotor development index 95.5 vs 95.8 respectively p = ns).

Conclusion

Neurodevelopmental outcome appears encouraging in this cohort although these infants are at high risk of prolonged initial hospitalisation and significant respiratory morbidity in the first two-years of life.     

Maternal use of selective serotonin reuptake inhibitors during pregnancy and neonatal bone density

Background

Selective serotonin reuptake inhibitors (SSRI) are commonly used to treat depression in pregnant women. Several adverse effects of prenatal SSRI exposure on the offspring have been described, including decreased growth. SSRI use by adults decreases bone mineral density, but this effect had not been examined in infants.

Aim

To examine growth parameters and bone mineral density of infants born to mothers using SSRIs during pregnancy.

Study design

Anthropometric variables and bone density were compared between 40 newborns exposed to SSRIs in utero, and 40 gestational-age matched control infants. Tibial bone speed of sound, a marker of bone density and strength, was measured using quantitative ultrasound. The difference in bone speed of sound between the two groups was compared using linear models, adjusting for relevant confounders.

Results

Infants in the SSRI-exposed group were shorter, with a marginal statistical significance (49.3 ± 2.1 vs. 50.1 ± 1.3 cm, p = 0.07), while mean birth weight did not differ substantially between study groups. Head circumference was significantly smaller in the SSRI group (33.8 ± 1.2 vs 34.4 ± 1.1 cm, p = 0.005), remaining so even after adjustment for several confounders. No considerable difference was found in the bone speed of sound between SSRI-exposed infants and controls (3011 ± 116 vs. 3029 ± 129 m/s).

Conclusions

We found no evidence that prenatal SSRI exposure hindered neonatal bone quality, yet a marginally shorter length and a smaller head circumference raise the possibility of an effect on bone growth. We conclude that the effect of SSRIs on fetal bone density seems minimal or absent.     

Hepatic aminotransferases of normal and IUGR fetuses in cord blood at birth

Background

The accepted standard for assessing the wellbeing of the newborn is the Apgar score and blood gas analysis. However, the prediction of neonatal morbidity or mortality is limited. In small-for-gestation (SGA) fetuses at 18–38 weeks of gestation, pO₂ is < 5th centile both in the umbilical artery and vein in 30%. In a previous study in singleton term neonates cardiac specific enzymes (B-type natriuretic peptide, BNP and cardiac troponin T, cTnT) are increased in growth-restricted fetuses compared with normals.

Aims

To test the hypothesis, that fetuses with intra uterine growth restriction (IUGR) have elevated AST (GOT) and ALT (GPT) aminotransferases as a result of hypoxic liver cell injury, and to establish references ranges.

Study design

Prospective cohort study, serum of umbilical artery (n = 156) and vein (n = 180), 599 normal singletons at 37^+ 0–42^+ 0 weeks, neonates with IUGR (n = 41), analysis for pH, birthweight and maternal weight, spontaneous vs cesarean section, vein vs artery and for the sex.

Outcome measures

Aspartate aminotransferase (AST, GOT) and Alanine aminotransferase (ALT, GPT) were measured in normals and IUGR neonates.

Results

Neonates with IUGR (n = 41) had AST values that were not different from the reference group, but had significantly lower ALT (− 1.49, 95% CI − 1.98 to − 1.00 vs 0.14, 95% CI − 0.42–0.13), (p < 0.001), (Fig. 3).

Conclusions

In neonates with IUGR, hypoxic hepatic injury markers in cord blood were not elevated. Rather, a substantially reduced ALT suggests a down-regulated hepatic activity.