Social competence of preschool children born very preterm

Background

Relatively little is known about the early social development of children born very preterm despite clear suggestions of later interpersonal difficulties.

Aims

To compare the social competence of very preterm (VPT) and full term (FT) born children at age 4 and identify infant, social and family factors associated with later risk.

Study design

Prospective longitudinal study.

Subjects

A regionally representative cohort of 103 VPT (≤ 32 weeks gestation) children and a comparison group of 105 FT children (36–41 weeks gestation) born between 1998 and 2000.

Outcome measures

At corrected age 4 years, a range of parent report, observational and laboratory measures assessed children's emotional and behavioral adjustment, emotional regulation, social interactive behavior and theory of mind understanding. Extensive perinatal, social background and family functioning data were also available from birth to age 4.

Results

Compared to their FT peers, VPT born children had poorer emotional and behavioral adjustment, were less effective in regulating their emotions, had lower levels of positive peer play and had less synchronous interactions with their parents. Within the VPT group, predictors of poor social competence included family socioeconomic disadvantage, extreme prematurity, severity of cerebral white matter abnormalities and early childhood exposure to high levels of maternal anxiety and negative parenting.

Conclusions

VPT pre-schoolers are characterized by a range of subtle social difficulties likely to adversely affect their ability to establish and maintain positive relationships with others. These difficulties need to be monitored alongside other potential neurodevelopmental concerns and parents supported to actively nurture child social competence.     

Neurophysiological evaluation in children with Friedreich's ataxia

Introduction

In children with Friedreich's ataxia (FRDA children), clinical ataxia outcomes are hardly substantiated by underlying neurophysiological parameters. In young FRDA children, some reports (based upon International Cooperative Ataxia Rating Scale scores (ICARS)) mention transient neurological improvement upon idebenone treatment. However, these outcomes are obtained with adult instead of pediatric reference values. It is unknown whether age-related neurophysiological parameters can really substantiate neurologic improvement.

Aim

In young FRDA children, we aimed to determine longitudinal neurophysiological parameters during idebenone treatment.

Methods

During a two-year study period, 6 genetically proven FRDA children with cardiomyopathy (6-18 years) were longitudinally assessed for neurophysiological parameters [sensory evoked potentials (SEPs), F response, peripheral nerve conduction and dynamometry] in association with age-matched ICARS-scores.

Results

In all FRDA children, SEPs remained absent during the two-year study period. Peroneal nerve conduction velocity declined (from − 1SD to − 2SD; p < .05), whereas F responses remained essentially unaltered. Total muscle force and leg muscle force decreased (from − 2 to − 3SD and − 2.5 to − 3.5SD; both p < .05) and age-related ICARS-scores deteriorated (median increase + 41%; p < .05).

Conclusion

In FRDA children, age-related neurophysiological and ataxia parameters deteriorate during idebenone treatment. Although we cannot exclude some (subjective) disease stabilization, age-related neurophysiological parameters do not substantiate neurologic improvement.     

Functional impairments at school age of preterm born children with late-onset sepsis

Background

Late-onset sepsis is a relatively common complication particularly of preterm birth that affects approximately a quarter of very low birth weight infants.

Aim

We aimed to determine the motor, cognitive, and behavioural outcome at school age of preterm children with late-onset sepsis compared to matched controls.

Study design and subjects

A prospective case-control study that included preterm infants (gestational age < 32 weeks and/or birth weight < 1500 g) admitted to our Neonatal Intensive Care Unit in 2000-2001 with a culture-proven late-onset sepsis, and controls matched for gestational age.

Outcome measures

At school age we assessed motor skills, intelligence, visual perception, visuomotor integration, verbal memory, attention, executive functioning, and behaviour.

Results

At 6-9 years, 21 of 32 children with late-onset sepsis (68%) had borderline or abnormal motor outcome with most problems in fine motor skills. Their total IQ was 89 compared to 98 in controls. In addition, verbal memory and attention were affected compared to controls (0.61 standard deviations (SD), 95% confidence interval (CI) 0.04-1.17, p = 0.033 and 0.94 SD, 95% CI 0.32-1.62, p = 0.011, respectively). Multiple episodes of sepsis and gram-negative sepsis were risk factors for worse cognitive outcome.

Conclusions

At school age, a majority of preterm children with late-onset sepsis had motor problems. Their IQ was considerably lower than matched controls, and memory and attention were specifically impaired. Outcome at school age of preterm children with late-onset sepsis was worse than previously thought.     

Behavioural problems at the age of eleven years in preterm-born children with or without fetal brain sparing: A prospective cohort study

Background

In severe intrauterine growth restriction (IUGR) due to placental insufficiency a haemodynamic adaptation occurs, resulting in preferential blood flow to the fetal brain (brain sparing). With Doppler ultrasound an increased ratio between the umbilical and the cerebral artery pulsatility index (U/C ratio) can be demonstrated. IUGR is associated with impaired neurodevelopmental outcome.

Objective

Evaluation of the effect of fetal brain sparing on behavioural problems at eleven years in premature born children.

Methods

Prospective cohort study in premature children born in 1989, with a gestational age of 26 0/7 to 33 0/7 weeks. An U/C ratio > 0.72 was defined as brain sparing. Behavioural problems were assessed with the parent-reported Child Behaviour Check List (CBCL) and the Teacher's Report Form (TRF). T scores > 60 for total problem score and subscales of internalizing and externalizing behaviour, were considered abnormal.

Results

Ninety-eight of the 116 survivors were assessed, of which 31 with antenatally established fetal brain sparing. According to the CBCL-total problem score 23.3% of the premature born babies in the brain sparing group had behavioural problems compared with 22.8% of those without brain sparing. According to the TRF-total problem score the percentages were 21.4% and 20.0%, respectively. Logistic regression analysis failed to show a significant association of U/C ratio with behavioural problems. In this model oxygen dependency at 28 days, IQ < 85 at five years, cranial ultrasound abnormalities, fetal growth ratio < 0.80, Apgar scores < 7 after 5 min and birth weight < p10 contributed significantly.

Conclusion

In this cohort brain sparing itself has no significant association with behavioural problems at eleven years.     

Nutritional and socioeconomic factors in motor development of Santal children of the Purulia district, India

Aims

The aim of this study was to characterize the motor development of 5-12 year-old Santal children of the Purulia district of West Bengal, India. The effect of socioeconomic and nutritional status on motor development was also examined.

Study design

841 (427 boys and 414 girls) Santal children were examined in this cross-sectional study. The nutritional status of each child was assessed by height-for-age z-score based on WHO reference data. Socioeconomic status (SES) was measured by the updated Kuppusswami scale. Motor development was measured using the Bruininks-Oseretsky Test of Motor Proficiency-Second Edition, Short Form (BOT-2).

Results

Sex had a significant (p < 0.05) effect on children's score of running speed and agility, upper-limb coordination and strength with higher scores for boys than girls. Children with a height-for-age z-score of − 2 or less were significantly more likely to have a total BOT-2 z-score of − 2 or less compared with children at a healthier height-for-age range (Χ² = 271.136, p < 0.0001). Well-nourished children scored significantly higher (p < 0.05) than undernourished children in total BOT-2 score and in all individual motor subtests. Regression analysis showed that nutritional status, socioeconomic status and height have a significant impact on total BOT-2 score (p < 0.001). Age and sex were found to be influencing factors in motor development.

Conclusion

Santal children's motor proficiency is around the 1st percentile when compared with normative BOT-2 data. This may be, in part, a result of nutritional and economic disparities between children on who the BOT-2 was normed and Santal children, supporting the role of nutrition in motor development. Additionally, Santal children with lower SES and poorer nutritional status have lower motor proficiency compared with Santal children with comparatively higher SES and nutritional status.     

Prenatal stress and infant affective reactivity at five months of age

Background

Prospective studies concerning prenatal stress and its outcome on children's emotional development postulated a potential influence of prenatal hormonal levels or emotional stressors on child development [1-3]. In a retrospective study, an influence of maternal emotional stress on infant affective reactivity was found [4].

Aims

This study was conducted in order to confirm these findings in a prospective study design.

Study design

A prospective longitudinal study design was conducted with three study waves during pregnancy and one time point five months postnatally.

Subjects

The final sample consisted of n = 104 mother-infant dyads.

Outcome measures

Maternal baseline cortisol levels and emotional stress were assessed in each trimester of pregnancy. Children were examined with the infant reactivity battery according to Kagan & Snidman [5] at the age of five months.

Results

Mothers of children with high affective reactivity (cry score ≥ 7) were significantly less depressed (p < .10) and perceived less stress (p < .05) in mid-pregnancy and were confronted with less external stress factors (p < .10) at the end of pregnancy. Cortisol levels did not differ in both groups in any pregnancy trimenon (p > .05).

Conclusions

These data add a new specific aspect to the ‘fetal programming hypothesis’ and are the first to confirm the speculative data from retrospective studies. Baseline cortisol does not seem to be the ‘hormonal mediator’ of this association. Therefore, cortisol stress reactivity or other neuroendocrine mechanisms should be assessed in future studies.     

Antioxidant vitamin status during pregnancy in relation to cognitive development in the first two years of life

Objective

To investigate the correlation of the antioxidant vitamins status (vitamins A, E and C) during pregnancy and the intellectual development of early childhood.

Method

A total of 150 paired maternal-neonatal subjects were recruited into the present study. The serum concentrations of antioxidant vitamins (vitamins A, E and C) in maternal blood and cord blood after delivery were determined by high performance liquid chromatography and the intellectual development was evaluated by Gesell Development Schedules (GDS) at two-years-old.

Result

Children with higher cord serum vitamin E level showed higher scores of motor, adaptive domain and average compared to children with lower cord serum vitamin E level (p < 0.01 or 0.05), respectively. Cord serum vitamin A level had significant positive correlation with effect on motor DQs (β = 4.227, p < 0.05), and vitamin E level in cord blood showed a positive relation with motor DQ and average DQ (β = 0.329 and 0.1875, respectively, p < 0.05) in multiple linear regression model.The language and social DQs were influenced by placental vitamin E transport rate (β = 3.1968 and 3.0194, respectively, p < 0.05). The placental transport rate of vitamin E also was a protective factor for the prevalence of motor behavior developmental delay [OR: 0.118, 95% confident interval (95% CI), 0.018-0.765, p = 0.0251], personal and social behavior developmental delay (OR: 0.052, 95% CI: 0.004-0.610, p = 0.0185) and average developmental delay (OR: 0.041, 95% CI: 0.003-0.642, p = 0.0229) in logistic multiple regression model.

Conclusion

Data suggested that vitamin A, E status and vitamin E transfer rate at delivery had beneficial influence on children's cognitive and behavior development quotients.     

The effects of multiple pre- and perinatal risk factors on the occurrence of cerebral palsy. A Norwegian register based study

Aims

To examine the effects of multiple risk factors on cerebral palsy (CP).

Materials/methods

For 176,591 Norwegian infants born 1996-98 and surviving the early neonatal period, data on a number of potential pre- and perinatal risk factors (RFs) for CP were available in the Medical Birth Registry of Norway. For 241 children with CP detailed clinical data were available in the Norwegian CP registry.

Results

In children born at term, 31% had no RF, and none had five or more, while in children born preterm, 9% had no RF in addition to prematurity (p < 0.001 vs. term), and 5% had five or more (p < 0.02 vs. term). In both groups, few children shared the same combination of RFs. Interdependent sequences were more often observed among children born preterm than at term (p < 0.001 vs. term). The most detrimental effect was observed for the combination of maternal disease and low 5-min Apgar score, registered in 11.2% of children with CP. The combination of maternal disease and premature birth had an interaction contrast ratio of 9.25 (CI: 3.56; 14.94), which may be consistent with biological interaction.

Conclusions

The majority of children with CP born at term most likely had an antenatal or single cause, suggesting individual susceptibility to an injury. The majority of children born preterm, had combinations or sequences of antenatal and perinatal risk factors as the most likely cause of CP.     

Visuospatial and verbal fluency relative deficits in ‘complicated’ late-preterm preschool children

Background

Late-preterm children constitute a majority of all preterm deliveries (75%). Their immature brain development at birth has been associated with an increased risk for morbidities. Data have been sparse regarding neuropsychological outcomes in the preschool years.

Aim

To examine general cognition, attention/working memory, language, manual coordination/motor dexterity, visuomotor, visuospatial, and executive functions in preschoolers born late-preterm (LPT; 34-36 gestational weeks) who required NICU admission compared to term-born participants.

Design

Single-center retrospective cohort study of 95 three-year-old children; 60 born LPT in 2004-2005 and admitted to the NICU compared to 35 healthy term-born participants born ≥ 37 gestational weeks and ≥ 2500 g.

Results

LPT birth was associated with visuospatial (p = .005), visuomotor (p = .012), and executive function (noun [p = .018] and action-verb [p = .026] fluency) relative deficits, but not attention/working memory, receptive or expressive language, nonverbal reasoning, or manual coordination/dexterity deficit.

Conclusions

Late-preterm birth is likely to be associated with negative neuropsychological sequelae, although subtle and selective compared to effects reported for children born at an earlier gestational age. Visuospatial function appears to be especially vulnerable to disruption even at preschool age, and verbal fluency may be useful as an early predictor of executive dysfunction in childhood. Routine preschool neuropsychological evaluation is recommended to identify delay or deficit in LPT children preparing for school entry, and may highlight underlying vulnerable neural networks in LPT children.     

Maternal asthma, race and low birth weight deliveries

Background

Asthma during pregnancy may compromise the well-being of the fetus and potentially impact an infant's birth weight via different mechanisms.

Aims

1) To assess the influence of asthma during pregnancy on the incidence of LBW outcomes in white non-Hispanic (WNH) and black non-Hispanic (BNH) women. 2) To identify other risk factors that affect low birth weight (LBW) (birth weight < 2500 g) outcomes among asthmatic women.

Design/subjects

We conducted a retrospective analysis of compiled perinatal data on 17,073 patients including 9348 WNH and 7725 BNH women delivering at the George Washington University Hospital between 1990 and 2003. Univariate and logistic regression analyses were used to examine associations.

Results

A total of 423 (2.5%) women had an asthma diagnosis, with a higher incidence in BNH women when compared to WNH women (3.4% vs. 1.7%, P < 0.001). In the WNH population, asthmatic women had higher incidences of gravidity, thyroid disease, and illicit drug use, whereas in the BNH population, asthmatic women had higher incidences of increased body mass index (BMI), and use of alcohol, tobacco and illicit drugs. After controlling for confounders in multiple logistic regression analyses, there was an association between asthma and LBW outcomes in BNH women (OR: 1.7, CI: 1.1-2.6, p = 0.01), but not in WNH women (OR = 0.99, CI = 0.5-2.2, p = 0.97).

Conclusions

Asthma during pregnancy is a risk factor for LBW outcomes in BNH but not WNH women. The increased alcohol and illicit drug use in BNH women with asthma is an unexpected finding that deserves further study.     

Different functional cardiac characteristics observed in term/preterm neonates by echocardiography and tissue doppler imaging

Background and aim

To establish, using echocardiography, color-flow Doppler and tissue doppler imaging (TDI), physiological values of systolic/diastolic indexes in healthy term/pre-term newborns, and to identify how different degrees of maturity influence morpho-functional cardiac alterations during the transitional period.

Study design and subjects

33 term newborns (M = 19, F = 14; gestational ages: 37th-41st week), and 20 pre-term infants (M = 11, F = 9; gestational ages: 31st-36th week) admitted to our department were studied. All infants underwent to clinical and Doppler ultrasound evaluations, carried out by the third to fourth day. Investigations included: M-mode echocardiography, color-flow Doppler and TDI.

Outcome measures and results

Term and preterm neonates differed for: interventricular septum and left systolic/diastolic ventricle diameters (p < 0.01 and < 0.05 respectively); left ventricle posterior wall in systole (p < 0.01); shortening and ejection fraction (p < 0.05). Color-flow Doppler parameters on the tricuspid (peak E, peak A, ratio E/A; p < 0.05) and on the mitral (peak E and E/A ratio; p < 0.01) significantly differed between the two groups. Significant differences were also present for basal left ventricular lateral wall and right ventricular lateral wall in the Ew (p < 0.01 and < 0.05 respectively), Sw peak (p < 0.01 and < 0.05 respectively), and Ew/Aw (p < 0.05). The isovolumetric relax time and the E/Ew measured on the medial mitral annulus also demonstrated significant differences (p < 0.01) between the two groups.

Conclusions

TDI is feasible in preterm neonates and enables assessment of myocardial velocities. With increasing gestational age, higher myocardial velocities and lower E/E′ Œ ratios were found. TDI addition to standard neonatal echocardiography may provide further important information about cardiac function.     

Family functioning, burden and parenting stress 2 years after very preterm birth

Background

Examining rates of difficulties in family functioning following very preterm birth has been a relatively neglected area of research.

Aims

To examine family functioning, burden and parenting stress in families with very preterm compared with term born children, and investigate influences of parental mental health problems and child neurodevelopmental disability on family outcomes in families with preterm children.

Study design

Participants were 184 very preterm and 71 term children and their parents. Parents completed the Family Assessment Device, Parenting Stress Index and Impact on Family questionnaires when their children were 2 years old (corrected for prematurity). Parental mental health and social risk information were also collected. Children were assessed for neurodevelopmental disability.

Results

Families with very preterm children reported poorer family functioning (p = .03) compared with families with term born children, with less evidence for differences between families with very preterm and term born children in parenting stress and family burden. Within very preterm families, parental mental health problems were associated with higher levels of parenting stress (p = .001), and parents of children with a neurodevelopmental disability were more likely to report higher family burden (p = .04).

Conclusions

For families with very preterm children, parental mental health symptoms and child neurodevelopmental disability may identify families at risk of greater stress and burden who may benefit from additional support.     

Oxidative stress after antenatal betamethasone: Acute downregulation of glutathione peroxidase-3

Background

Human and experimental data show that antenatal exposure to glucocorticoids (GC) temporarily reduces fetal well-being and impairs the fetal response to hypoxemia.

Aims

We tested the hypothesis that antenatal betamethasone provokes transient oxidative stress, which may be triggered directly by the GC or indirectly by metabolic signals such as increased glucose and free fatty acid (FFA) concentrations.

Study design

Prospective (single center, 18 months) cohort study in newborns < 34 weeks gestational age at birth.

Methods

We studied 105 newborns and measured oxidative damage to lipids [malondialdehyde (MDA)] and proteins (protein carbonyls), as well as glutathione peroxidase-3 (GPx3), an important antioxidant enzyme, in umbilical vein (UV) plasma. In addition, we measured umbilical artery and UV blood gases, and metabolic indices (plasma glucose, FFA and insulin) in UV.

Results

MDA but not protein carbonyl concentrations was inversely related to time elapsed since the first or last betamethasone administration (p = 0.006); MDA remained elevated by 69-96% for at least 72 h after the last betamethasone. By contrast, GPx3 concentrations were repressed in newborns who received betamethasone ≤ 24 h before birth. GPx3 and MDA concentrations were correlated (r = − 0.38, p < 0.001). Labor, GA, sex, size at birth, blood gases or metabolic indices did not explain the effects of betamethasone on MDA and GPx3.

Conclusions

Antenatal GC elicit a rapid suppression of the GPx3 antioxidant defense system which may contribute to a longer-lasting but also transient rise in lipid oxidative damage.     

Quantitative analysis of maturational changes in EEG background activity in very preterm infants with a normal neurodevelopment at 1 year of age

Background

The electroencephalographic (EEG) background pattern of preterm infants changes with postmenstrual age (PMA) from discontinuous activity to continuous activity. However, changes in discontinuity have been investigated by visual analysis only.

Aim

To investigate the maturational changes in EEG discontinuity in healthy preterm infants using an automated EEG detection algorithm.

Study design

Weekly 4 h EEG recordings were performed in preterm infants with a gestational age (GA) < 32 weeks and normal neurological follow-up at 1 year. The channel C3-C4 was analyzed using an algorithm which automatically detects periods of EEG inactivity (interburst intervals). The interburst-burst ratio (IBR, percentage of EEG inactivity during a moving time window of 600 s) and mean length of the interburst intervals were calculated. Using the IBR, discontinuous background activity (periods with high IBR) and continuous background activity (periods with low IBR) were automatically detected and their mean length during each recording was calculated. Data were analyzed with regression and multivariate analysis.

Results

79 recordings were performed in 18 infants. All recordings showed a cyclical pattern in EEG discontinuity. With advancing PMA, IBR (R² = 0.64; p < 0.001), interburst interval length (R² = 0.43; p < 0.001) and length of discontinuous activity (R² = 0.38; p < 0.001) decreased, while continuous activity increased (R² = 0.50; p < 0.001). Multivariate analysis showed that all EEG discontinuity parameters were equally influenced by GA and postnatal age.

Conclusion

Analyzing EEG background activity in preterm infants is feasible with an automated algorithm and shows maturational changes of several EEG derived parameters. The cyclical pattern in IBR suggests brain organisation in preterm infant.     

Amplitude-integrated electroencephalographic activity is suppressed in preterm infants with high scores on illness severity

Background

The neonatal acute physiology score, SNAP-II, reflects the severity of illness in newborns. In term newborns, amplitude integrated EEG (aEEG), is depressed following asphyxia. In preterm infants aEEG is discontinuous, and therefore more difficult to assess compared to term infants.

Aims

Our first aim was to investigate whether assessing aEEG amplitudes by calculating amplitude centiles was consistent with assessment by pattern recognition. Our second aim was to investigate whether the aEEGs of preterm infants were influenced by SNAP-II.

Study Design and Subjects

We recorded aEEGs in 38 infants with a mean gestational age of 29.7 weeks (26.0-31.8 weeks) during the first five days of life. The mean recording time was 130 min. The aEEGs were assessed by pattern recognition, by calculating Burdjalov score, and by calculating the mean values of the 5th, 50th, and 95th centiles of the aEEG amplitudes. Illness severity was determined within the first 24 h.

Results

We assessed 151 recordings and found strong correlations between the 5th and 50th amplitude centiles and the Burdjalov scores (r = 0.71, p < 0.001 and r = 0.47, p < 0.001, respectively). The 5th and 50th amplitude centiles correlated with SNAP-II (r = − 0.34, p < 0.0001 and r = − 0.27, p = 0.001). These correlations were the strongest on the first day of life (r = − 0.55, p = 0.005 and r = − 0.47, p = 0.018, respectively). The 5th and the 50th amplitude centiles were best predicted by gestational age, SNAP-II, and low blood pressure.

Conclusions

Severe illness as measured by the SNAP-II, and low blood pressure had a negative influence on the aEEGs of preterm infants.     

Changes in physiological and behavioural pain indicators over time in preterm and term infants at risk for neurologic impairment

Background

Approximately 10% of infants admitted to a Neonatal Intensive Care Unit (NICU) are at risk for Neurological Impairment (NI). While we have limited knowledge on the influence of NI risk on pain responses, we have no knowledge of how these responses change over time.

Objective

To compare physiological and behavioural pain responses of infants at three levels of NI risk during the NICU neonatal period (Session 1) and at 6 months of age (Session 2).

Design/methods

Prospective observational design with 149 preterm and term infants at high (Cohort A, n = 54), moderate (Cohort B, n = 45) and mild (Cohort C, n = 50) risks for NI from 3 Canadian tertiary level NICUs. Infants were observed in the NICU during 3 standardized phases of a heel lance: baseline, stick and return-to-baseline. At 6 months, infants were observed during the same three phases during an intramuscular immunization injection. Physiological (heart rate, oxygen saturation) and behavioural (9 facial actions, cry) responses were continuously recorded.

Results

A significant interaction of Phase by Session was found with less total facial activity observed during Session 2 (all p values < 0.04). A significant interaction for Session by Cohort was found, showing that infants in Cohort A had significantly more change from baseline-to-stick phase for brow bulge, eye squeeze, nasolabial furrow and open lips between sessions with less facial actions demonstrated at Session 2 (all p < 0.02). There were significantly lower mean and minimum heart rate (all p < 0.02) and higher minimum and maximum oxygen saturation (p < 0.04) at Session 2. Significantly higher mean and minimum fundamental cry frequencies (pitch) in Cohort B (p < 0.04) were found in Session 1. Cohort A had significantly longer cry durations, but no significant differences in cry dysphonation.

Conclusions

Behavioural and physiological infant pain responses were generally diminished at 6 months of age compared to those in the neonatal period with some differences between NI risk groups in cry responses. Future exploration into the explanation for these differences between sessions and cohorts is warranted.     

Postnatal growth of preterm born children ≤ 750g at birth

Background

Extremely low birth weight (ELBW) infants are at risk of impaired postnatal growth. Impaired postnatal growth has been reported to be associated with delayed cognitive and motor development.

Aims

To describe postnatal growth patterns of appropriate and small for gestational age (AGA and SGA) ELBW children in relation to their cognitive and motor outcome at age 5.5.

Study design

Retrospective cohort study.

Subjects

One hundred one children with a BW ≤ 750 g, born between 1996 and 2005 in the University Hospital Utrecht, The Netherlands.

Outcome measures

Height (Ht), weight (Wt), occipital-frontal circumference (OFC) at birth, 15 months and 2 years corrected age and 3.5 and 5.5 years.Cognitive and motor outcome at 5.5 years of age, classified as normal (Z-score ≥−1), mildly delayed (−2 ≤ Z-score <−1) or severely delayed (Z-score <−2). AGA (Ht, Wt or OFC at birth ≥−2 SDS) infants were compared with SGA (Ht, Wt or OFC at birth <−2 SDS) infants.

Results

Between birth and 5.5 years catch-up growth in Ht, weight for height (Wt/Ht), Wt and OFC was seen in 72.2%, 55.2%, 28.6% and 68.9% respectively of the SGA infants. For AGA infants we found substantial catch-down growth in Ht (15.4%) and Wt (33.8%). Cognitive and motor outcome was normal in 76.2% and 41.6% of the 101 children. A significantly higher percentage of normal cognitive outcome was found in AGA infants with Wt growth remaining at ≥−2 SDS compared to AGA infants with catch-down growth (83% vs 63%). Next, SGA infants who caught-up in OFC had a higher prevalence of normal cognitive outcome compared to SGA infants who did not catch-up in OFC. Furthermore, a higher percentage of severely delayed motor outcome was found in SGA infants without catch-up growth in Wt compared to SGA infants who caught-up in Wt (61.5% vs 32.2%).

Conclusions

Catch-up growth in Ht, Wt/Ht and OFC occurred in the majority of the SGA infants with a BW ≤ 750 g, but was less common in Wt. AGA children who remained their Wt at ≥−2 SDS have a better cognitive and motor developmental outcome at 5.5 years of age. Catch-up growth in OFC was associated with a better cognitive outcome at 5.5 years of age.     

A patient care system for early 3.0 Tesla magnetic resonance imaging of very low birth weight infants

Background

Very low birth weight (VLBW) infants (weight < 1500 g) are increasingly cared for without prolonged periods of positive pressure ventilation (PPV).

Aims

To develop a system for 3.0 T magnetic resonance (MR) image acquisition from VLBW infants who are not receiving PPV, and to test the clinical stability of a consecutive cohort of such infants.

Design

Seventy VLBW infants whose median weight at image acquisition was 940 g (590-1490) underwent brain MR imaging with the developed care system as participants in research. Twenty infants (29%) received nasal continuous positive airway pressure (nCPAP), 28 (40%) received supplemental oxygen by nasal cannulae, and 22 (31%) breathed spontaneously in air during the MR examination.

Results

There were no significant adverse events. Seventy-six percent had none or transient self-correcting oxygen desaturations. Desaturations that required interruption of the scan for assessment were less common among infants receiving nCPAP (2/20) or breathing spontaneously in air (2/22), compared with those receiving nasal cannulae oxygen (13/28), p = 0.003. Sixty-four (91%) infants had an axillary temperature ≥ 36 °C at completion of the scan (lowest 35.7 °C), There was no relationship between weight (p = 0.167) or use of nCPAP (p = 0.453) and axillary temperature < 36 °C. No infant became hyperthermic.

Conclusion

VLBW infants who do not require ventilation by endotracheal tube can be imaged successfully and safely at 3.0 T, including those receiving nCPAP from a customised system.     

Conductive hearing loss in children with bronchopulmonary dysplasia: A longitudinal follow-up study in children aged between 6 and 24 months

Aims

To determine the occurrence of isolated and recurrent episodes of conductive hearing loss (CHL) during the first two years of life in very low birth weight (VLBW) infants with and without bronchopulmonary dysplasia (BPD).

Study design, subjects and outcome measures

In a longitudinal clinical study, 187 children were evaluated at 6, 9, 12, 15 18 and 24 months of age by visual reinforcement audiometry, tympanometry and auditory brain response system.

Results

Of the children with BPD, 54.5% presented with episodes of CHL, as opposed to 34.7% of the children without BPD. This difference was found to be statistically significant. The recurrent or persistent episodes were more frequent among children with BPD (25.7%) than among those without BPD (8.3%). The independent variables that contributed to this finding were small for gestational age and a 5 min Apgar score.

Conclusions

Recurrent CHL episodes are more frequent among VLBW infants with BPD than among VLBW infants without BPD.