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.     

A comparison of executive function in very preterm and term infants at 8 months corrected age

Background

Executive function (EF) emerges in infancy and continues to develop throughout childhood. Executive dysfunction is believed to contribute to learning and attention problems in children at school age. Children born very preterm are more prone to these problems than their full-term peers.

Aim

To compare EF in very preterm and full-term infants at 8 months after expected date of delivery.

Subjects

37 very preterm infants without identified disabilities, and 74 gender and age matched healthy full-term infants. The very preterm infants were all ≤ 32 weeks gestation and < 1250 g birthweight.

Outcome measures

EF tasks which measured working memory, inhibition of distraction, and planning at 8 months after expected date of delivery.

Results

The very preterm infants performed significantly more poorly than the full-term infants on all measures of executive function. No significant differences were found between very preterm and full-term infants on any of potentially confounding variables of, infant temperament, maternal education, family income and maternal psychological wellbeing. Very preterm infants had significantly lower scores on the Mental Development Index (MDI) and Psychomotor Development Index (PDI) on the Bayley Scales of Infant Development (BSID II), however when this was partialled out the differences in EF scores remained. Medical complications, lower birthweight and lower gestation age were all found to adversely affect the performance of very preterm infants on executive function tasks.

Conclusion

Very preterm infants performed more poorly than full-term infants on measures of EF. Further follow up studies are required to investigate whether EF measures in infancy can predict learning and attention outcome at school age.     

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.     

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.     

Cognitive deficit in preschoolers born late-preterm

Background

Late-preterm (LPT) birth accounts for a majority of preterm deliveries and until recently was considered low risk for poor cognitive outcome. Previously, we reported deficits in complicated LPT (cLPT) preschoolers (neonatal intensive care unit [NICU]-admitted).

Aim

To extend our prior study by comparing cognitive outcome in cLPT and uncomplicated LPT (uLPT; NICU non-admitted) preschoolers.

Study design

Single center retrospective cohort study of 118 LPT children born in 2004-2006 at 35-36 weeks of gestation; 90 cLPT and 28 uLPT, compared with 100 term-born (≥ 37 weeks of gestation and ≥ 2500 g) participants.

Outcome measure

A well-standardized measure of general conceptual ability (GCA), the Differential Ability Scales, Second Edition.

Results

cLPT participants had average mean performances but significantly poorer GCA, Nonverbal Reasoning, and Spatial scores than term-born children, and higher rates of Nonverbal Reasoning and Spatial impairment; uLPT did not differ from TERM. Combined LPT males were at eightfold greater risk than term-born males for nonverbal deficit, and at sevenfold greater risk for GCA impairment than LPT females.

Conclusions

Finding greater risk of cognitive deficit in those NICU-admitted due to clinical instability or birth weight < 2 kg compared with non-admitted preschoolers indicates that neonatal morbidities contribute to subtle cognitive deficits detectable at young age, with male gender an additive risk factor. LPT gestational age alone is an insufficient predictor of long-term neurocognitive outcome. Further study should elucidate salient etiologies for early emerging cognitive weaknesses and suggest appropriate interventions to prepare at-risk LPT preschoolers for elementary school entry.     

Perceptions of Parenting Children With Type 1 Diabetes Diagnosed in Early Childhood

Introduction

The purpose of this study was to explore perceptions of psychosocial adaptations in parenting young children with type 1 diabetes (T1DM) from diagnosis through childhood.

Method

Fourteen parents of 11 children with T1DM who were diagnosed at age five years or younger participated in semi-structured interviews. Data were analyzed using content analysis.

Results

Three significant themes were identified. In the theme “Diagnostic Experiences: Frustrations, Fears, and Doubts,” parents described inadequate diagnostic experiences with pediatricians where concerns were minimized and diagnosis was sometimes delayed. Although hospitalization occurred abruptly, communication with specialists was more satisfactory. In the theme “Adapting to Diabetes,” parents described isolation in caring for their child's T1DM. Family and friends had minimal understanding of T1DM care. Support groups lessened mothers' isolation, but fathers were less positive about this experience. Parental adaptation was more effective when responsibility for diabetes decision making was shared. All parents reported never mastering diabetes management. The theme “Negotiating Developmental Transitions” revealed that normative childhood events were stressful, requiring that parents balance concerns to foster their child's participation.

Conclusions

Pediatric providers can improve diagnostic and treatment experiences for parents of children with T1DM by recognizing feelings of isolation and lack of mastery, providing attentive communication, encouraging parental teamwork, and offering ongoing anticipatory guidance.     

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.     

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.     

Effects of preterm birth and fetal growth retardation on cardiovascular risk factors in young adulthood

Background

The association between low birth weight (LBW) and increased risk of obesity, hypertension and cardiovascular disease later in life is well documented in epidemiological studies. However, clinical follow-up studies of LBW populations have only partly supported this.

Aims

Evaluate associations between LBW and body fat, blood pressure (BP), lung and endothelial function, and maximal oxygen uptake (VO_2max) in 18 year old young adults.

Subjects

Thirty-seven subjects born prematurely with birth weight < 1501 g (VLBW group), 47 born at term with low weight (< 10th centile) for gestational age (SGA group) and 63 controls with normal birth weight participated in the study.

Outcome measures

Anthropometric measurements, BP, endothelial function, lung function and VO_2max were recorded.

Results

Both LBW groups were shorter, lighter, had smaller head circumference and higher subscapular-to-triceps skinfold-ratio than controls. Systolic and mean arterial BP was higher in the VLBW compared with the control group, whereas there were no differences between the groups in endothelial function. The VLBW group had reduced dynamic lung volumes lower carbon monoxide transfer factor and lower VO_2max compared with controls. In particular young adults born VLBW who were also growth retarded in utero had higher indices of central body fat, higher BP and lower VO_2max.

Conclusion

We found that very preterm birth, but not growth retardation at term, was associated with higher BP and a less favourable fat distribution. In particular, the young adults born VLBW who were also growth retarded in utero had less favourable outcomes.     

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.     

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.     

Visual, motor and perceptual abilities at school age in children with isolated mild antenatal ventricular dilatation

Background

The detection of prenatal ventriculomegaly raises anxiety about possible neurological sequelae. A few studies have investigated possible neurodevelopmental sequelae in the first years after birth but no systematic assessment has been performed at school age.

Aims

The aim of this study was to assess minor neurological signs, perceptual and visual function in a cohort of children with isolated mild antenatal ventricular dilatation examined at school age.

Study design

Seventeen children with evidence of mild antenatal ventriculomegaly in the second and third trimester of pregnancy were included in the study.

Outcome measures

Children were assessed at school age (range 5 years 3 months-11 years, 11 months) using a structured neurological examination for minor neurological signs and age specific tests assessing perceptual motor abilities (Developmental Test of Visual-Motor Integration; Movement Assessment Battery for Children).

Results

Only one of the 17 children had abnormal results. The remaining 16 had normal results on all the tests, irrespective of the magnitude and the symmetry of the dilatation or of its evolution on neonatal scan.

Conclusions

Our results suggest that children who had mild isolated prenatal ventricular dilatation are unlikely to develop even minor motor or perceptual difficulties at school age.     

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.     

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.     

Behavioural problems in school age children with cerebral palsy

Background

Although behavioural problems are frequent in children with Cerebral Palsy (CP), the exact nature of these difficulties and their relationship with intrinsic or extrinsic factors are just beginning to be explored.

Aim

To describe and characterize behavioural problems in children with CP and to determine the nature of any relationships with child and family characteristics.

Methods

In this cross-sectional study, children with CP between 6 and 12 years of age were recruited. Children were assessed using the Leiter Intelligence Test, the Gross Motor Function Measure, the Strengths and Difficulties Questionnaire (SDQ), the Vineland Adaptive Behavior Scales and questionnaires on demographic factors. Parents’ level of stress was measured with the Parenting Stress Index.

Results

Seventy-six parents completed the SDQ. Using the Total Difficulties Scores, 39.4% of the sample scored in the borderline to clinically abnormal range. Peer problems were the most common (55.3%). High parental stress was consistently associated with behavioural difficulties across all domains of the SDQ. Not surprisingly, better socialization skills and a lower parental stress were correlated with more positive behaviours.

Conclusion

Behavioural difficulties are common in children with CP and appear not to be associated with socio-demographic variables and physical and cognitive characteristics. These difficulties are an important correlate of parental distress. This study emphasizes the need to recognize and address behavioural difficulties that may arise so as to optimize the health and well-being of children with CP and their families.     

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.     

Socioeconomic status, anthropometric status, and psychomotor development of Kenyan children from resource-limited settings: a path-analytic study

Background

Sub-optimal physical growth has been suggested as a key pathway between the effect of environmental risk and developmental outcome.

Aim

To determine if anthropometric status mediates the relation between socioeconomic status and psychomotor development of young children in resource-limited settings.

Study design

A cross-sectional study design was used.

Subjects

A total of 204 (105 girls) children from two resource-limited communities in the Coast Province, Kenya. The mean age of these children was 29 months (SD = 3.43; range: 24-35 months).

Outcome measure

Psychomotor functioning was assessed using a locally developed and validated measure, the Kilifi Developmental Inventory.

Results

A significant association was found between anthropometric status (as measured by weight-for-age, height-for-age, mid-upper arm circumference, and head circumference) and psychomotor functioning and also between socioeconomic status and anthropometric status; no direct effects were found between socioeconomic status and developmental outcome. The models showed that weight, height and to a lesser extent mid-upper arm circumference mediate the relation between socioeconomic status and developmental outcome, while head circumference did not show the same effect.

Conclusion

Among children under 3 years living in poverty, anthropometric status shows a clear association with psychomotor development while socioeconomic status may only have an indirect association.     

Inter-observer reliability of the “Assessment of Motor Repertoire — 3 to 5 Months” based on video recordings of infants

Objective

A detailed analysis of infant motor behaviour can show up indicators for later neurological impairment. The “Assessment of Motor Repertoire — 3 to 5 Months”, which is part of Prechtl's general movement assessment, could potentially be used for this purpose. The aim of the present study was to investigate inter-observer reliability in this instrument.

Method

Video recordings of 24 infants (corrected ages 3 to 5 months, gestational ages 24 to 42 weeks) were analysed by four observers. Kappa and ICC statistics were applied in the reliability analysis.

Results

High to very high inter-observer reliability was found in the assessment of “Fidgety Movements” (kappa 0.75-0.91). Agreement on the “Movement Character” was also high (kappa 0.54-0.84), while the assessment of the “Posture” showed the lowest inter-observer reliability (kappa 0.39-0.56). Moderate to high inter-observer reliability (kappa 0.51-0.84) was achieved in the field “Quality of Other Movements”, and moderate in “Repertoire of Co-Existent Other Movements” (kappa 0.51-0.69).Inter-observer reliability in the assessment of the total “Motor Optimality Score” was very high between all four observers as intraclass correlation coefficient (2,1) was 0.87, and ICCs for the pairwise analyses ranged between 0.80 and 0.94.

Conclusion

Inter-observer reliability in the “Assessment of Motor Repertoire — 3 to 5 Months” was satisfactory in respect of the subcategories and in case of high and low total optimality scores in pairwise assessments. In the total optimality scores, however, there was some inconsistency in the middle range of the scale.     

Very-low-birthweight and term small-for-gestational-age adolescents: attention revisited

AIM: To assess whether adolescents with very low birthweight (VLBW) and peers born small for gestational age (SGA) at term are at a disadvantage when attending to or executing tasks. METHODS: Cohorts of 54 VLBW (相似文献   

Reach on sound: a key to object permanence in visually impaired children

Background

The capacity to reach an object presented through sound clue indicates, in the blind child, the acquisition of object permanence and gives information over his/her cognitive development.

Aim

To assess cognitive development in congenitally blind children with or without multiple disabilities.

Study design

Cohort study.

Subjects

Thirty-seven congenitally blind subjects (17 with associated multiple disabilities, 20 mainly blind) were enrolled.

Outcome measures

We used Bigelow's protocol to evaluate “reach on sound” capacity over time (at 6, 12, 18, 24, and 36 months), and a battery of clinical, neurophysiological and cognitive instruments to assess clinical features.

Results

Tasks n.1 to 5 were acquired by most of the mainly blind children by 12 months of age. Task 6 coincided with a drop in performance, and the acquisition of the subsequent tasks showed a less agehomogeneous pattern. In blind children with multiple disabilities, task acquisition rates were lower, with the curves dipping in relation to the more complex tasks.

Conclusions

The mainly blind subjects managed to overcome Fraiberg's “conceptual problem” — i.e., they acquired the ability to attribute an external object with identity and substance even when it manifested its presence through sound only — and thus developed the ability to reach an object presented through sound. Instead, most of the blind children with multiple disabilities presented poor performances on the “reach on sound” protocol and were unable, before 36 months of age, to develop the strategies needed to resolve Fraiberg's “conceptual problem”.