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.     

Pattern visual evoked potential performance in preterm preschoolers with average intelligence quotients

Background

Preterm infants are more likely to develop visual perceptual and visual-motor impairments. Visual perceptual deficiencies may contribute to significant difficulties in daily life, but few reports are available relating electrophysiological assessment of the visual system to spatial information problems in premature preschoolers with average intelligence quotients.

Aim

This study was designed to investigate preterm preschoolers' responses to various spatial frequencies of pattern reversal visual evoked potential (PRVEP) and compare them to normal children.

Design

Participants were 20 very low birth weight (VLBW), 41 low birth weight (LBW) and 41 normal children who were 4 to 6 years old and were free from major disability and developmentally appropriate for gestational age at birth. They were evaluated using the Chinese population adaptation of the Wechsler Preschool and Primary Scale of Intelligence (WPPSI) and recorded PRVEP at five levels of spatial frequency (checkerboard pattern (check) sizes of 108′, 54′, 27′, 13′ and 7′) using a VikingQuest-IV neuroelectrophysiological device (Nicolet, Madison, WI, USA).

Results

Compared with normal children, the LBW and VLBW groups had significantly lower level in the tests of verbal, performance and overall intelligence quotients, particularly in performance, although the levels were within the average range. The PRVEP P100 wave latencies were significantly prolonged at all five degrees of spatial frequency in the VLBW group compared with the controls, while showing delay in the LBW with 13′ and 7′ check size. In the meanwhile, the amplitudes of P100 at all five spatial frequencies were significantly smaller in the VLBW and LBW groups than in the normal children. And VLBW group had even lower P100 amplitudes than the LBW group.

Conclusions

Preterm preschoolers with average cognition capability are at risk of defect in visual-spatial perception, especially when they are confronted with more complicated information. PRVEP may provide an objective and convenient measurement in detecting the problem of visual perception in children.     

Long-term development of low-risk low birth weight preterm born infants: Neurodevelopmental aspects from childhood to late adolescence

Background

Most studies on clinical outcome of preterm born infants focus on high-risk infants, whereas little is known about the long-term prognosis of low-risk low birth weight preterm born infants (LBW).

Aims

To examine physical growth, school outcome, behavioural aspects, quality of life, and intervention impact on LBW in late adolescence compared to term born controls and to analyse developmental pathways from childhood to adolescence for these groups.

Study design

In late adolescence 65 LBW and 41 matched term born controls were assessed with a structured telephone interview and standardized questionnaires with regard to physical growth, school career, therapeutic interventions, behavioural aspects, and quality of life. Longitudinal analysis comprised data from birth, infancy, school age, and adolescence.

Results

Growth in height of LBW was highly variable, but correlated significantly with birth parameters and was below those of controls with regard to percentiles. School enrollment of LBW was more often delayed, and there was a trend toward lower school graduation in LBW. The groups did not differ with regard to general or health-related quality of life and behavioural aspects, but LBW received significantly more therapeutical interventions.

Conclusions

In general, LBW showed no major deficits in late adolescence. However, a prolonged school career and a higher demand for therapeutic interventions indicate subtle neurodevelopmental deficits in LBW. This underscores the need for professional follow-up programmes for this majority of preterm born infants.     

Executive function deficit in preschool children born very low birth weight with normal early development

Background

Many studies showed that children born very low birth weight (VLBW) are at high risk of executive function (EF) deficit, including impulse control, working memory and cognitive flexibility. However, they did not exclude the influence of abnormal early development on EF deficit.

Aims

The aim was to investigate if six-year-old VLBW children with normal early development still have EF deficit.

Methods

The research was conducted in two groups. The VLBW group included 37 children at aged 6, with more than 70 of Bayley Scales of Infant Development-Second Edition (BSIDII) before aged 2. The normal group included 22 term children aged 6 who were born healthy and developed normally, with comparable IQ and social economic status. Five instruments, including Comprehensive Nonverbal Attention Test Battery (CNAT), Tower of London (ToL), Wisconsin Card Sorting Test (WCST), Knox's Cube Test and Digit Span Subtest of WISC-IV, were analyzed to evaluate four kinds of EF, including impulse control, planning, cognitive flexibility and working memory.

Results

The EF of VLBW group was significantly lower in independent t-test on the scores of planning in ToL, cognitive flexibility in WCST and nonverbal working memory in Knox's Cube Test. Yet, the inferiority in EF of VLBW group became less significant when ANCOVA analysis was used to adjust gestation age and birth weight.

Conclusions

Six-year-old VLBW children even with normal early development are still at risk of deficits in “planning”, “cognitive flexibility” and “nonverbal working memory” while the preterm factors, both gestation age and birth weight, were important covariant factors.     

Neurodevelopmental outcomes of very low birth weight and extremely low birth weight infants at 18 months of corrected age associated with prenatal risk factors

Background

Very premature infants occasionally have neurodevelopmental disabilities. However, there have been quite limited data on prenatal risk factors associated with their neurodevelopmental outcomes.

Aim

To clarify the relationship between prenatal risk factors and neurodevelopmental outcomes of very premature infants.

Study design

The study design is a retrospective review.

Subjects

One hundred seventy Japanese women with a singleton pregnancy and their infants whose birth weight being less than 1500 g were included. We classified those infants into 118 appropriate for gestational age (AGA) and 52 small for gestational age (SGA) infants.

Outcome measures

Infants' neurodevelopmental outcomes at 18 months of corrected age were evaluated by the Kyoto Scale of Psychological Development 2001 (KSPD). We analyzed and compared the infants' outcomes and prenatal risk factors between two groups.

Results

Mortality and rate of infants unevaluable by KSPD because of severe impairment were not significantly different between those groups. However, the developmental quotient score of the cognitive-adaptive area in SGA infants born between 25 and 31 weeks of gestation was significantly lower than that in AGA infants randomly selected as gestation-matched controls. More advanced gestational age and heavier birth weight protected against adverse neurodevelopmental outcomes in both groups. Moreover, male infants were related to the excess risk of adverse neurodevelopmental outcomes in the SGA group.

Conclusion

In view of the neurodevelopment of the infants, it seems that the most efficient obstetric strategy for improving prognosis of premature infants should be targeted to prolong the pregnancy period as long as the reassuring fetal status and maternal stable health condition are being confirmed.     

Patterns in sleep-wakefulness in three-month old infants exposed to methadone or buprenorphine

Background

Infants exposed to opioides in-utero frequently demonstrate withdrawal symptoms in the neonatal period and have difficulties with state regulation.

Aim

This study examines sleep-wakefulness-distress patterns as indicators of regulatory mechanisms at 3 months of age.

Participants

A national infant cohort (N = 35) born to women in high-dose maintenance treatment during pregnancy and a comparison group (N = 36) of low-risk infants born in the same period.

Outcome measures

Distributions and frequencies of sleep, wakefulness and distress measured in hours and episodes on sleep charts recorded by the mothers in the two groups.

Results

Women in maintenance treatment were monitored closely during pregnancy to avoid illicit drug use and to be prepared for motherhood. They were also offered residential treatment before pregnancy and after the child was born. There were no statistical differences between the two groups in any of the 10 measures reflecting diurnal and nocturnal rhythmicity at 3 months despite of neonatal abstinence syndrome in 47% of the exposed infants and significant differences in infant characteristics with respect to birth weight, gestational age and maternal characteristics.

Conclusions

Follow-up procedures combining drug monitoring and counseling during pregnancy and in the first months after birth enhance the development of state regulation in terms of sleep-wakefulness patterns.     

Hypothyroxinemia and effectiveness of thyroxin supplementation in very low birth weight infants with abdominal distension and poor weight gain

Background

Very low birth weight (VLBW) infants sometimes develop abdominal distension and poor weight gain. The influence of thyroid function on these symptoms in VLBW infants has not been reported.

Methods

In a retrospective study, 18 VLBW infants whose abdominal distension and poor weight gain did not improve with standard treatment were enrolled as subjects. Serum levels of free thyroxin (fT₄) and thyroid stimulating hormone (TSH) were measured. Subjects with serum fT₄ levels less than 1.3 ng/dl received thyroxin supplementation. Another 18 VLBW infants were recruited as age- and weight-matched controls. We compared degree of intestinal dilation on X-ray, weight gain, and quantity of milk tolerated before and after starting thyroxin supplementation in the subjects and the controls.

Results

All subjects had serum fT₄ levels less than 1.3 ng/dl (mean, 0.72 ng/dl). TSH values varied widely and were less than 8 µU/ml in 12 subjects. Therefore, all subjects received thyroxin supplementation; after starting this, mean serum fT₄ level increased significantly to 1.31 ng/dl. In parallel with fT₄ increase, intestinal dilation improved in 16 of 18 subjects (mean grade of dilation decreased from 2.8 to 1.6). Weight gain and quantity of tolerated milk were significantly increased with thyroxin supplementation in all and 17 of the 18 subjects, respectively.

Conclusions

Thyroxin supplementation was effective in improving abdominal symptoms in VLBW infants whose serum fT₄ level was less than 1.3 ng/dl.     

Parental bilingualism is associated with slower cognitive development in very low birth weight infants

Background

Speech development is frequently impaired in very low birth weight (VLBW) infants. Few and controversial data have been published on concepts regarding the influence of bilingual education.

Aims

The objectives of the current study were to assess the influence of parental bilingualism on speech development and neurodevelopmental outcome in low risk VLBW infants.

Study design

Monocentric prospective controlled cohort study with standardized follow-up.

Subjects

We recruited 50 singleton VLBW infants each from monolingual and bilingual families as well as 90 term control infants. The infants were free of disease and congenital malformation.

Outcome measures

Griffiths scales of infant development at the corrected ages of 6 and 12 months, Bayley Scales of Infant Development II (BSID II) with 22 months.

Results

In general, both bilingual and monolingual VLBW infants achieved age-specific milestones at the corrected age of 6, 12 and 22 months. However, bilingual VLBW infants achieved significantly lower scores than their monolingual peers in all cognitive subscales. The influence of maternal education on the neurodevelopmental outcome of the preterm infants was not significant; the subscales' correlation with socioeconomic or biological parameters was poor. However, a clear differentiation between social status and bilingual environment importance for speech development was not possible.

Conclusions

In the setting of the present investigation, parental bilingualism is associated with slower neurodevelopment in VLBW infants during the first 2 years of life.     

Intergenerational birth weight associations by mother's birth order — The mechanisms behind the paradox: A population-based cohort study

Background

Mother's birth order is inversely associated with offspring birth weight despite positively associated with the mother's own birth weight. The causes behind this relation have not been elucidated.

Aims

To investigate the relation between mother's birth order and birth weight of her offspring, with emphasis on possible mechanisms behind the findings.

Study design

Population based cohort study over two generations.

Subjects

Data were from the Medical Birth Registry of Norway, based on all births in Norway, 1967-2006 (2.3 million births). Units where both mothers and offspring were singletons and offspring were first born were included, forming 272,674 mother-offspring units for the analyses.

Outcome measure

Birth weight in the second generation.

Results

Mother's birth weight increased steadily with increasing birth order from 3369 g for first born to 3538 g for fourth or later born mothers. In contrast, there was a monotonic decrease in offspring mean birth weight with increasing mother's birth order (9.1 g per birth order (95% C.I.; 6.8, 11.4)). First born mothers tended to be older, to have higher education, to more often be married or cohabiting, and to smoke less than later born mothers at the time of their first pregnancy.

Conclusion

The general reduction in mean birth weight among first born mothers was not observed in the next generation. We suggest that first born mothers have the same biologically potential for achieving similar sized offspring as later born mothers, and that social factors account for the inverse relation.     

Neurodevelopmental outcome after COX inhibitor treatment for patent ductus arteriosus

Aim

To compare neurodevelopmental results in very low birth weight (VLBW) infants two years after successful or failed cyclooxygenase inhibitor treatment with either indomethacin or ibuprofen for a haemodynamically significant patent ductus arteriosus (hsPDA).

Methods

We retrospectively evaluated closure rates and outcome parameters of VLBW infants with hsPDA 89 of whom were treated with indomethacin and 93 with ibuprofen.

Results

Indomethacin and ibuprofen therapy groups did not differ in their baseline clinical profile (median gestational age 26.0 and 26.2 wks d) in early (median CRIB 6 and 5, respiratory distress > 2° in 36 and 34 infants) and late morbidities (intraventricular hemorrhage > 2° in 9 and 10 infants, bronchopulmonary dysplasia in 31 and 27 infants, 80 and 85 survivors), PDA closure rates (63 and 58%) or neurodevelopmental outcome. The therapy failure group (54 infants) was characterized by lower median gestational age (25.0 wks d) and higher mortality (17%). No differences were found in the neurodevelopmental outcome of the surviving infants with ligation as compared to the survivors with successful pharmacological closure of the PDA at 24 months corrected age.

Conclusion

Use of either ibuprofen or indomethacin for closure of a hsPDA did not influence two year neurodevelopmental outcomes in VLBW infants.     

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.     

Growth and health outcome of 102 2-year-old children conceived after preimplantation genetic diagnosis or screening

Objective

The major objective of this study was to determine whether the embryo biopsy procedure might cause growth restriction or affect health outcome of children.

Study design

Auxological data and physical findings were compared at birth and age 2 for 102 children (70 singletons and 32 twins) born after PGD/PGS and 102 matched children born after intracytoplasmic sperm injection (ICSI) in a prospective study.

Results

No statistically significant differences regarding weight, height and head circumference standard deviation scores (SDS) at birth and at age two years were observed. At two years of age the mean BMI SDS tended to be lower in PGD/PGS children (p = 0.058). PGD/PGS babies had been more often breastfed (p = 0.013), but mostly during a shorter time.The prevalence of major as well as minor congenital anomalies, hospital admissions and surgical interventions was similar.

Conclusion

Children born after embryo biopsy applied in PGD/PGS present similar prenatal and postnatal growth and health outcome in the first two years of life compared to ICSI children. Up till now, PGD and PGS appear not to be associated with a higher risk for health problems.     

Impact of very low birth weight infants on the family at 3 months corrected age

Background

Very low birth weight infants (VLBW, <1500 g) have increased impact on families compared to term infants. However, there is limited research examining this impact in the first months post-discharge.

Aim

To determine maternal, neonatal, and infant characteristics associated with greater impact on the family at 3 months corrected age in VLBW infants. It was hypothesized that social/environmental and medical risk factors would be associated with higher impact.

Study design

Maternal, neonatal, and infant data were collected prospectively. Parents completed the Impact on Family, Family Support, and Family Resource Scales. Associations between characteristics and impact scores were analyzed by t-test and Pearson's correlation. Regression models for each impact score identified significant risk factors for impact.

Subjects

152 VLBW infants born February 28, 2007 to September 5, 2008 who had a follow-up evaluation at 3 months corrected age.

Outcome measure

Impact on family.

Results

Siblings in the home, neonatal medical risk factors, longer hospitalization, more days on ventilator or oxygen, lower gestational age, lower social support, and poorer family resources were associated with increased impact. Multivariate analyses identified siblings in the home, poorer family resources, lower gestational age, and oxygen requirement at 3 months as the most important predictors of impact.

Conclusions

Social/environmental and medical risk factors contribute to impact on family. Families with identified risk factors should receive support services to assist them in coping with the burden of caring for a VLBW infant.     

Comparison of salivary cortisol, heart rate, and oxygen saturation between early skin-to-skin contact with different initiation and duration times in healthy, full-term infants

Background

There are few studies that compare the physiological and biological efficacies between different early skin-to-skin contacts (SSC) post birth.

Aim

To investigate physiologically and biochemically how early SSC with different initiation and duration time influence the stress post birth for full-term infants.

Study design

Non-experimental study.

Subjects

Study I; Thirty-two infants who began SSC 5 min or less [birth SSC, mean initiation time (standard deviation): 1.6 (1.1) min] after birth and 36 infants who did so more than 5 min [very early SSC, 26.3 (5.0) min] in heart rate (HR) and oxygen saturation (SpO₂) analysis. Study II; Eighteen infants who underwent SSC for 60 min or less [mean initiation time: 7.5 (12.2) min] and 61 infants who did so for more than 60 min [15.3 (12.5) min] in salivary cortisol analysis.

Outcome measures

HR and SpO₂ measured for 30 min post birth. Salivary cortisol concentration measured at 1 min, 60 min, and 120 min post birth.

Results

Birth SSC group reached HR stability of 120-160 bpm significantly faster than very early SSC group by Kaplan-Meier analysis (P = 0.001 by log-rank test). As for SpO₂ stability of 92% and 96%, no significantly between-group difference was found. Salivary cortisol levels were significantly lower between 60 and 120 min after birth in SSC group, continuing for more than 60 min compared with SSC group for 60 min or less after adjustment for salivary cortisol level at 1 min besides the infant stress factors (P = 0.046).

Conclusions

Earlier SSC beginning within 5 min post birth and longer SSC continuing for more than 60 min within 120 min post birth are beneficial for stability of cardiopulmonary dynamics and the reduction of infant stress during the early period post birth.     

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.     

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.     

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.     

Persistent maternal anxiety affects the interaction between mothers and their very low birthweight children at 24 months

Background

Parental distress following the birth of a premature infant diminishes the parent's ability to be sensitive to the infant's cues, and this may affect infant developmental outcomes.

Aims

The present study examined the effects of maternal anxiety during infant hospitalization in the Neonatal Intensive Care Unit (NICU) on the interactive behavior of mothers with their very low birthweight (VLBW) children in toddlerhood.

Subjects

A sample of 56 mothers and their VLBW infants were recruited in the NICU.

Study design

During the infant's NICU stay, mothers completed a self-report measure of trait anxiety. These mothers and their infants were followed when the infants were 24 months corrected age, when mothers and their children were videotaped during free play at home. These videotapes were then coded using the Emotional Availability Scales.

Results

Maternal anxiety was not found to be related to severity of neonatal illness. Maternal anxiety in the NICU was associated with less sensitivity and less structure in interaction with their toddlers at 24 months corrected age, even controlling for maternal education and child birthweight. Children of mothers with higher anxiety scores in the NICU were less likely to involve their mothers in their play at 24 months corrected age.

Conclusions

Maternal anxiety in the NICU predicted adverse interactive behaviors when the children were 24 months corrected age. Early identification of anxious mothers in the NICU is needed in order to initiate preventive intervention to support the mother-infant relationship.     

Maternal anxiety is related to infant neurological condition, paternal anxiety is not

Background

Parental anxiety and stress may have consequences for infant neurological development.

Aims

To study relationships between parental anxiety or well-being and infant neurological development approximately one year after birth.

Study design

Longitudinal study of a birth cohort of infants born to subfertile couples. Subjects: 206 parent-child dyads.

Outcome measures

Infant neurology was assessed with the Touwen Infant Neurological Examination (TINE) at 10 months and a developmental questionnaire at 12 months. Parental measures included trait anxiety measured by the State-Trait Anxiety Inventory (STAI) and well-being measured by the General Health Questionnaire (GHQ).

Results

Maternal trait anxiety was associated with a less optimal neurological condition (r_s = − 0.19, p < 0.01) of the infant. This association persisted after adjusting for confounders and results were confirmed by the outcome of the developmental questionnaire. Paternal trait anxiety and parental well-being were not related to the infant's neurodevelopmental outcome.

Conclusions

Infants of mothers with high trait anxiety have an increased vulnerability to develop a non-optimal nervous system. The association may be mediated in part by early programming of monoaminergic systems. Future research should include an exploration of specific windows of vulnerability to maternal anxiety.     

Support for the global feasibility of the Ages and Stages Questionnaire as developmental screener

Objective

To investigate the psychometric properties of the Dutch version of the 48 months Ages and Stages Questionnaire (D_ASQ_48).

Design

Prospective cohort study of a community-based sample of children born in 2002 and 2003 whose parents filled out the D_ASQ_48 and a questionnaire on school status at 60 months. The ASQ was translated into Dutch and back-translated into English by three independent translators.

Setting

Well Child Centers covering 25% of the Netherlands.

Participants

Parents of 1510 preterm and 562 term children born in 2002-2003 attending routine Well Child visits at age 45-50 months.

Main outcome measures

Reliability, validity and mean population scores for D_ASQ_48 compared to other countries.

Results

Mean population scores for the D_ASQ_48 were mostly similar to those in the USA, Norway and Korea. Exceptions (effect sizes of difference > 0.5) were problem solving (USA) and fine motor (Korea). Reliability was good for the total score (Cronbach alpha 0.79) and acceptable for all domains (0.61-0.74). As expected, infants born at gestational age < 32 weeks, children from low income families, of low educated mothers, and boys were more likely to fail on several domains (odds ratios, OR ranging from 1.5 to 4.9). The only unexpected association concerned children from one-parent families. Sensitivity to predict special education at five years of age was 89% and specificity 80%.

Conclusions

The good psychometric properties of the Dutch ASQ_48 and the small differences when compared to other countries support its usefulness in the early detection of developmental problems amongst children worldwide.