Measuring developmental deficit in children born at gestational age less than 26 weeks using a parent-completed developmental questionnaire

AIM: To assess developmental deficit in children born at gestational age (GA) < 26 wk using a parental questionnaire and to use regression analysis to study a cohort born in 1999-2003. PATIENTS AND METHODS: Three groups were studied: group 1, GA < 26 wk; group 2, GA 26-27 wk; group 3, children born at term. The Ages & Stages Questionnaire (ASQ) was used. The parents of each child were mailed an age-specific questionnaire between November 2004 and April 2005. The term children were used as a reference to calculate a standard deviation score (ASQ-SDS) for each child in the two preterm groups. RESULTS: Seventy-five per cent of the questionnaires were returned (group 1: n=61; group 2: n=57; group 3: n=72). The age at scoring ranged from 12 to 60 mo (mean 32.8 mo). After correction for parental education, 22% of the children born at GA < 26 wk and 13% of those at GA 26-27 wk had an ASQ-SDS below -2. Chronic lung disease of prematurity was associated with developmental deficit (mean difference -1.1 ASQ-SDS, p=0.004). CONCLUSION: The ASQ identified a significant developmental deficit in the children born extremely preterm. The rate of 22%, however, in children born at GA < 26 wk is reassuring.     

Developmental delay at 12 months in children born extremely preterm

AIM: To evaluate the feasibility and validity of a structured telephone interview to assess the development of children born extremely preterm. METHODS: The parents of 88 children born with a gestational age below 28 wk admitted to the neonatal intensive care unit (NICU) at Rigshospitalet, Copenhagen, were interviewed by telephone when their child was 1 y of age, corrected for preterm birth. A fully structured questionnaire on psychomotor function was used (Revised Prescreening Developmental Questionnaire (R-PDQ)). The parents of 30 children born at term without complications were interviewed for comparison. The interview was conducted by NICU staff. To validate the R-PDQ, parents of 22 children in the preterm group and parents of 19 children in the reference group conducted an Ages and Stages Questionnaire (ASQ) when their children had reached the age of 3-3(1/2) y. RESULTS: The R-PDQ was easy to use by staff and well accepted by parents. The mean score in the preterm group was 14.9+/-3.9 vs 17.7+/-2.7 in the term group (p<0.001). Three children had developmental scores below-2 SD. The R-PDQ score was associated with the ASQ score 2 y later.CONCLUSION: A structured questionnaire administrated by telephone is an alternative and usable tool for assessing neurodevelopmental deficit in children born extremely preterm. The mean developmental delay in the preterm group compared to the term group (about-1 SD) was close to expectations.     

Sensorimotor skills associated with motor dysfunction in children born extremely preterm

Background

Children born prematurely, despite being free of intellectual and sensorineural deficits, are at risk of motor dysfunction.

Aim

To investigate the association of sensorimotor processing skills and Developmental Coordination Disorder (DCD) in “apparently normal” extreme preterm children.

Study design

In a matched case-control study, 50 preterm children born less than 29 weeks or birthweight < 1000 g, with an IQ > 85 and no identified sensorineural disability, were assessed at 8 years of age along with 50 gender and birth date matched classroom controls born at full term. A battery of sensorimotor tests was administered, which examined visual-motor, visual perception, tactile perception, kinaesthesia, and praxis.

Results

For preterm children with DCD (n = 21), significantly lower scores were found for the visual processing and praxis tests, with the exception of verbal command, in comparison to those 29 preterm children without DCD and term controls (median visual perception scores were 92, 96 and 108 respectively; design copying was 0.07, 0.46 and 0.95; constructive praxis was 0.09, 0.27 and 0.63; and sequencing praxis was 0.14, 0.73 and 0.96). There were no difference on the tactile sensitivity and kinaesthetic processing tests.

Conclusions

Preterm children with DCD have difficulty with visual processing tasks. Praxis or motor planning poses a particular challenge for them. Motor dysfunction in extremely preterm children was related to poorer visual processing and motor planning and may relate to a cognitive processing problem.     

Doxapram and developmental delay at 12 months in children born extremely preterm

AIM: To examine the relation of doxapram to a developmental score achieved by a structured telephone interview in a group of extremely-preterm-born children. METHODS: Parents of 88 children born extremely preterm were contacted by telephone and interviewed by a structured questionnaire (R-PDQ) when the corrected age of their child was 9-15 mo. RESULTS: We found that doxapram treatment was associated with a deficit in age-adjusted R-PDQ score.CONCLUSION: Doxapram may have a negative effect on neurodevelopmental outcome.     

Validity and internal consistency of the Ages and Stages Questionnaire 60-month version and the effect of three scoring methods

Background

The Ages and Stages Questionnaire (ASQ) is currently the most used parent-completed developmental screener consisting of different age-specific questionnaires. Psychometric evaluation of the ASQ 60-month version (ASQ-60) is limited. Furthermore, it is unclear which of the available scoring methods of the ASQ is most useful in the identification of children with potential developmental problems.

Aim

To evaluate the internal consistency and construct validity of the ASQ-60 with a large sample size, and to assess the effects of three scoring-methods on this validity.

Study design

Parents of 394 term-born and 1063 preterm-born children from the prospective cohort-study Lollipop completed the ASQ-60 and a general questionnaire on school-problems.

Outcome measures

Internal consistency and construct validity of the ASQ-60 were determined using the ASQ total score. Construct validity was also determined using two other types of scoring-methods based on low domain-scores (‘ASQ domain score’) and parental concerns (‘ASQ total score with parental concerns’).

Results

Cronbach's alpha for total score was 0.86, confirming internal consistency. Male gender, prematurity, low paternal education, low family income and small-for-gestational-age were associated with low ‘ASQ total scores,’ confirming construct validity. Regarding construct validity with special education as criterion, sensitivity was best using the ‘ASQ domain score’ or the ‘ASQ total score’ with parental concerns (both 0.96). However, the specificity was best (0.93) using the ASQ total score.

Conclusion

The ASQ-60 has a good internal consistency and validity to screen for developmental problems in the general population. The ‘ASQ total score’ has the best performance, the ‘ASQ domain score’ is recommended in case of preferred high sensitivity.     

Biological predictors and co-morbidity of attention deficit and hyperactivity disorder in extremely low birthweight infants at school

Objective: To examine biological predictors and co-morbidity of Attention Deficit Hyperactivity Disorder (ADHD) and associated academic and social impairment in a cohort of extremely low birthweight of (ELBW) children attending school.
Methodology: Eight seven (70%) of 125 ELBW children born between 1977 and 1986 were followed prospectively. Neonatal and biological data including cranial ultrasound for 62% of children, formal developmental assessment at 4 or 6 years of age, teacher and parent ADHD questionnaire, parental rating of health status and social impairment and school teacher rating of academic performance was recorded.
Results: Apart from grades 3 or 4 intraventricular haemorrhage in a minority of children, there was no evidence to suggest an association between ADHD and perinatal adversity in ELBW children. Social impairment, academic difficulty and atopic symptoms were significantly related to ADHD.
Conclusions: Extremely low birthweight children presenting with symptoms of ADHD are likely to suffer social and learning impairment and these, rather than perinatal risk factors, should be the focus of clinical attention.     

General movements and magnetic resonance imaging in the prediction of neuromotor outcome in children born extremely preterm

Background

Extremely preterm (EPT) birth is a major risk factor for brain injury and neurodevelopmental impairment. Reliable tools for early prediction of outcome are warranted.

Aim

To investigate the predictive value of general movements (GMs) at “fidgety age” for neurological outcome at age 30 months in EPT infants, both in comparison and in combination with structural magnetic resonance imaging (MRI) at term equivalent age (TEA).

Study design

Fifty-three infants born < 27 weeks of gestation were included prospectively. MRI was performed at TEA and images were evaluated for white and grey matter abnormalities. GMs were assessed at age 3 months corrected (“fidgety age”).

Outcome measures

Neuromotor outcome was assessed at age 30 months corrected. Children were classified as having a normal neurological status, unspecific signs, or cerebral palsy (CP).

Results

Abnormal GMs were a common finding, seen in 32% (17/53) of infants. Of these, six infants (11%) had definitely abnormal GMs. Four infants (8%) had a diagnosis of CP at follow up. Definitely abnormal GMs were significantly associated to CP at 30 months (Fisher's Exact test p = 0.03, sensitivity 50%, specificity 92%). Moderate–severe white matter abnormalities on MRI were more strongly associated with CP (Fisher's Exact test p < 0.001, sensitivity 100%, specificity 98%) than GMs. Combining GMs with MRI-findings at TEA increased the predictive specificity to 100% (Fisher's Exact test, p = 0.005), whereas sensitivity remained unchanged.

Conclusions

The presence of definitely abnormal GMs was predictive of CP: prediction was significantly enhanced when the GMs assessment was combined with findings from MRI obtained at TEA.     

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

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

Child and environmental factors associated with leisure participation in adolescents born extremely preterm

Background

Developmental impairments persist among adolescents born extremely preterm, and these individuals are at an increased risk for chronic disease later in life. Participating in active and positive leisure activities may act as a buffer against negative outcomes, but involvement in active-physical and skill-based activities is low in youth born preterm.

Aims

To explore the child and environmental determinants of leisure participation among adolescents born extremely preterm.

Study design

Cross-sectional study.

Subjects

Participants were recruited from the hospital's Neonatal Follow-Up Program and included 128 adolescents born preterm (mean gestational age: 26.5 weeks).

Outcome measures

Leisure participation was assessed using the Children's Assessment of Participation and Enjoyment. Potential determinants were assessed using standardized tests and questionnaires. Selected factors were entered into five separate multivariable regression models.

Results

Child and environmental factors contributed between 21% (skill-based) and 52% (active physical) of the adjusted variance for participation intensity. Lower gestational age was associated with greater participation in recreational activities. Male sex, higher maternal education and better motor competence were associated with involvement in active-physical activities. Being older and feeling socially accepted were associated with participation in social activities. Families oriented to hobbies and higher maternal education were associated with participation in skill-based activities. Preference was the strongest determinant of participation in all five leisure activities.

Conclusions

Activities should be adapted to individual skill level, include family and peers, foster social acceptance and be driven by the adolescent's preferences. Although certain factors cannot be modified, they can be used to identify adolescents at risk for low participation.     

Low Apgar score and mortality in extremely preterm neonates born in the United States

Aim: To investigate the relationship between low Apgar score and neonatal mortality in preterm neonates. Methods: Infant birth and death certificate data from the US National Center for Health Statistics for 2001–2002 were analysed. Primary outcome was 28‐day mortality for 690 933 neonates at gestational ages 24–36 weeks. Mortality rates were calculated for each combination of gestational age and 5‐min Apgar score. Relative risks of mortality, by high vs. low Apgar score, were calculated for each age. Results: Distribution of Apgar scores depended on gestational age, the youngest gestational ages having higher proportions of low Apgar scores. Median Apgar score ranged from 6 at 24 weeks, to 9 at 30–36 weeks gestation. The relative risk of death was significantly higher at Apgar scores 0–3 vs. 7–10, including at the youngest gestational ages, ranging from 3.1 (95% confidence interval 2.9, 3.4) at 24 weeks to 18.5 (95% confidence interval 15.7, 21.8) at 28 weeks. Conclusion: Low Apgar score was associated with increased mortality in premature neonates, including those at 24–28 weeks gestational age, and may be a useful tool for clinicians in assessing prognosis and for researchers as a risk prediction variable.