Longitudinal outcomes of very low birth weight: neuropsychological findings.

To investigate the effects of very low birth weight (VLBW, &1500 g) on the development of neuropsychological skills, we assessed 67 children with birth weight <750 g, 64 with birth weight 750-1499 g, and 67 term-born controls. Growth modeling of raw scores from mean ages 7-14 years revealed persistent VLBW sequelae. Even when adjusting for IQ, the <750 g group scored more poorly than the term-born group on measures of language processing, verbal list learning, and perceptual-motor and organizational abilities. This group also made slower age-related progress than the control group on tests of perceptual-motor and executive functions. Environmental factors moderated group differences in change on other cognitive measures. These results revealed further evidence for slower skill development in both VLBW groups relative to controls, as well as"catch-up" growth in the 750-1499 g group on some measures. The findings suggest age-related changes in the cognitive sequelae of VLBW that depend on the skill assessed, the degree of VLBW, and environmental factors.     

Long-term neuropsychological outcomes in very low birth weight children free of sensorineural impairments

This study investigated the neuropsychological outcomes at school age of children with very low birth weight (VLBW) free of sensorineural impairments. Subjects included 19 children with VLBW identified at age 3 as 'suspect' for developmental problems, 19 children with VLBW identified at age 3 as developing normally, and 30 children of normal birth weight (NBW). Results indicated that children in the VLBW 'suspect' group performed significantly more poorly on all of the neuropsychological measures compared to children of NBW. These findings suggest that VLBW children identified as 'suspect' for developmental problems because of impairments in cognitive skills at age 3 continued to show deficits at school age on intellectual and neuropsychological measures.     

Myelination in very low birth weight infants--evaluation by MRI

The prognostic significance of cerebral myelination was evaluated with magnetic resonance imaging (MRI) in very low birth weight infants. Myelination was graded in two specified sites, optic radiation and corpus callosum, based on the stages of normal term babies and healthy premature infants. The subjects were 30 preterm infants weighing less than 1,500 gm at birth. MRI was performed at 4 to 7 months (corrected age). The normal myelination stage was seen in 18 cases, while a delayed stage was noticed in 12 cases. In the normal myelination group, only 1 case (6%) had handicaps. In the delayed myelination group, 8 cases (67%) had handicaps. Our results showed that delayed myelination was closely related to a poor prognosis. We believe that MRI would be a very good imaging modality for predicting the outcome of very low birth weight infants, particularly in terms of evaluation of myelination.     

Long-term neuropsychological outcomes of very low birth weight: associations with early risks for periventricular brain insults.

Few follow-up studies of children with very low birth weight (VLBW, <1,500 g) have examined neuropsychological sequelae at later ages or neonatal risks as predictors of these outcomes. The present study assessed cognitive skills at mean age 16 years in 48 participants with <750 g birth weight, 47 with 750-1,499 g birth weight, and 52 term-born controls. Our major objectives were to delineate the long-term cognitive consequences of VLBW, and to determine if risks for periventricular brain insults accounted for variations in outcomes. Analysis revealed poorer outcomes for the <750 g group than for term-born controls on nearly all measures, with specific impairments in visual-motor skills, spatial memory, and executive function. Predictors of outcome for participants with VLBW included lower birth weight, lower weight for gestational age, and a longer period of oxygen requirement for chronic lung disease. The longer-term consequences of VLBW are consistent with expectations based on early brain pathology and suggest limitations to functional plasticity.     

Vocal development of infants with very low birth weight

This study describes the vocal development of infants born with very low birth weights (VLBW). Samples of vocalizations were recorded from three groups of infants when they were 8, 12 and 18 months of age: preterm VLBW infants with bronchopulmonary dysplasia (BPD), preterm VLBW infants without BPD, and healthy full-term infants. Infants with BPD produced significantly smaller canonical syllable ratios than the full-term infants throughout the period of study. Premature VLBW infants who did not suffer from BPD produced relatively little canonical babble at 8 months of age, but were performing within the range of the full-term infants at 18 months of age. At 18 months of age, the infants with BPD were reported to have significantly smaller expressive vocabulary sizes than the healthier preterm and full-term infants.     

Improved outcome for very low birth weight multiple births

This study describes time trends for very low birth weight multiple births in relation to very low birth weight singletons. Two cohorts of very low birth weight (less than 1250 gm) children recruited between 1983-85 (cohort 1, n = 115) and 1992-94 (cohort 2, n = 144) were compared. The Bayley Scales of Infant Development and a standardized neurologic examination were administered at 2 years corrected age. Neurodevelopmental outcome did not change between cohort 1 and 2 for singletons. For multiple births, mean Mental Developmental Index increased after adjustment for neonatal risk factors [adjusted mean (standard deviation) 81.8 (11.7) to 96.5 (18.6), analysis of covariance P = 0.007]. The prevalence of cerebral palsy decreased, however not significantly [adjusted odds ratio (95% confidence interval) 0.3 (0.1-1.5), P = 0.14]. The proportion of disease-free survival (no cerebral palsy and no developmental delay) increased for multiple births (7-37%, P = 0.002), but not for singletons. In cohort 2, neurodevelopmental outcome of multiple births was similar to that of singletons. The cognitive outcome of very low birth weight multiple births improved, possibly because of changes in perinatal practice. However, neurodevelopmental outcome was similar to that of very low birth weight singletons who were unaffected by changes in neonatal care with high proportions of motor delay and cerebral palsy.     

Secondary cystic lesions in the cerebellum in very low birth weight infants

We studied 4 very low birth weight infants with secondary cystic lesions in the cerebellum by serial cranial ultrasound and computed tomography. These infants presented severe respiratory distress, asphyxia at birth and intraventricular hemorrhage. In the neonatal period, cranial ultrasound examination showed significant intraventricular hemorrhage and posthemorrhagic ventricular dilatation with intraparenchymal hemorrhage. However, a cerebellar cyst was not seen in any of the infants. We found evidence of cerebellar hemorrhage by ultrasound in only one patient. Follow-up ultrasound examinations and CT scans showed progressive posthemorrhagic ventriculomegaly in three of the infants and large cystic lesions in the infratentorial area from 3 to 6 months old in all 4 infants. We conclude that the cystic lesions were caused by hemorrhagic and hypoxic-ischemic insults which occurred in very low birth weight infant.     

Neurological signs and assessment of extremely and very low birth weight infants

The infants' brain during the prenatal, perinatal and neonatal periods is susceptible to injury. Many problems in the perinatal period often result in bleeding, ischemia and other pathological changes in the infant brain. Which can subsequently cause cerebral palsy or developmental disorders. Unless they are discovered early and measures are taken, permanent brain damage may remain. Although neurological examinations at this stage is very difficult, it is very important to be familiar with neurological signs and assessment of extremely and very low birth weight infants and to discover early any abnormal findings of diseases such as neonatal asphyxia, intraventricular haemorrhage, periventricular leukomalacia, neonatal seizures and hydrocephalus.     

Neonatal neurology in extremely and very low birth weight infants: introductory remarks

Survival rates of extremely and very low birth weight infants have been improved dramatically. However, some of the survivors suffer from neurological sequelae. A recent report showed that about 25% of the children with birth weight of less than 1,000 g had some handicaps, including cerebral palsy, mental retardation, and visual disturbance. Therefore, it is very important for pediatric neurologists to assess the neurological symptoms properly in the neonatal period. This symposium was organized to present recent progress in the methods for neurological assessment and to discuss how we should support the development of high risk infants.     

Neurodevelopment in very low birth weight premature infants with postnatal subependymal cysts

The aim of this study was to investigate the neurodevelopmental outcome in very low birth weight infants with postnatal subependymal cysts. During a 3-year period, postnatal subependymal cysts were diagnosed by serial cranial ultrasound in 21 very low birth weight infants born prior to 33 weeks' gestation. These infants and 116 healthy very low birth weight controls were evaluated with the Bayley Scales of Infant Development at 2 years of age. Preterm infants with postnatal subependymal cysts had a significantly lower Psychomotor Development Index (P = .034) and were more likely than the normal group to have motor developmental delay (Psychomotor Development Index <70) (P = .013). The findings indicate that postnatal subependymal cyst is a significant risk factor for impaired motor development in very low birth weight infants (odds ratio 5.73, 95% confidence interval 1.57-20.97).     

储液囊埋植引流治疗极低体质量早产儿脑室内出血致脑积水的疗效分析

目的 评估储液囊埋植引流治疗极低体质量早产儿脑室内出血致脑积水的疗效分析.方法 回顾性分析2005年1月至2011年6月期间,温州医学院第二附属医院收治的12例出生时体质量＜1 500 g的极低体质量早产儿脑室内出血合并脑积水,进行储液囊埋植引流治疗.储液囊埋植后根据临床表现和影像学检查结果,决定脑脊液引流次数,间歇引流时间和引流量,并观察术后的并发症.若储液囊引流无效者,改行脑室一腹腔分流术.结果 12例脑室出血Ⅲ级8例,Ⅳ级4例,孕龄26 ～ 32周,出生时平均体质量为(1023 ±223)g.埋植Ommaya储液囊时日龄为(17.7±3.1)d,平均体质量为(1 126±236)g.术后1例患儿死于肺部相关并发症,存活的11例患儿中,7例未发现脑室进行性扩大,3例取出储液囊.4例出现脑积水,行脑室一腹腔分流术,并同时取出储液囊.储液囊埋植引流的相关主要并发症(皮肤裂开、脑脊液漏、脑脊液感染、脑室出血)发生率为6/12例(50％),3例出现皮肤切口裂开合并发生脑脊液感染,2例单独出现脑脊液感染,l例术后出现脑室出血.结论 储液囊脑室埋植引流治疗极低体质量早产儿脑室内出血致脑积水具有操作简单、疗效满意、预防或减轻部分患儿脑积水的进一步发展、避免行永久性分流术等优点,但其并发症的发生率相对较高,采用改良的手术方法可降低并发症的发生.     

Developmental outcome of very low birth weight infants requiring a ventriculo-peritoneal shunt

All infants of less than 1,500 g birth weight who required a ventriculo-peritoneal shunt were followed for developmental problems over the 1st year of life. There were 19 infants; 2 died within the 1st postoperative week. At 1 year of age corrected for prematurity the mean Bayley Mental Developmental Index was 62 +/- 23.0, and the mean Psychomotor Developmental Index was 61 +/- 19. Only 2 infants attained scores greater than 85 on both scales, while an additional 2 infants attained a score of greater than 85 on one scale. It is concluded that ventriculo-peritoneal shunting procedures performed after progressive ventricular enlargement has taken place are not likely to result in normal development of the infant less than 1,500 g birth weight.     

Outcome of very low birth weight infants with sonographic enlarged occipital horn

The objective of this study is to compare the neurodevelopmental outcome between very low birth weight infants with and without sonographic disproportionate enlargement of occipital horn. We retrospectively reviewed the brain sonography of all very low birth weight infants born at National Taiwan University Hospital between June 1997 and June 1999. Brain sonography was routinely performed at the age of the third, seventh, twenty-first, and later days as clinically indicated. Intracranial hemorrhage, periventricular leukomalacia, congenital hydrocephalus, and Stage III retinopathy of prematurity were excluded from our study because of the association with neurodevelopmental impairment. Patients with disproportional dilatation of occipital horn more than 15 mm in width were included in the study group, and those with less than 15 mm were in the control group. Both groups received developmental evaluation by the Bayley Scales of Infant Development II at corrected age of 6, 12, 18, and 24 months, respectively. Socioeconomic status and detailed medical history were obtained at assessments. Independent-samples t test was used for comparison. A total of 81 very low birth weight infants were included in this study: 49 infants (female 18, male 31) in the study group and 32 infants (female 23, male 9) in the control group. The mean gestation in these two groups was 30 +/- 2 weeks and 31.1 +/- 2.2 weeks (P = 0.156), and the mean birth body weight was 1290 +/- 269 gm and 1282 +/- 219 gm (P = 0.877), respectively. At corrected age of 24 months, there was no significant difference in muscle tone, neuromotor impairment, hearing impairment, vision, or speech development. Assessment with the mental development index (88.9 +/- 15.6 vs 93 +/- 13.2) (P = 0.238) and the psychomotor development index (93.3 +/- 10.3 vs 89.6 +/- 12.1) (P = 0.149) between these two groups was also comparable. This retrospective analysis suggests that ultrasonographic disproportionate enlargement of the occipital horn in very low birth weight infants does not affect the neuromotor development at corrected ages of 6, 12, 18, and 24 months.     

Visual perception and visual-motor integration in very preterm and/or very low birth weight children: a meta-analysis

A range of neurobehavioral impairments, including impaired visual perception and visual-motor integration, are found in very preterm born children, but reported findings show great variability. We aimed to aggregate the existing literature using meta-analysis, in order to provide robust estimates of the effect of very preterm birth on visual perceptive and visual-motor integration abilities. Very preterm born children showed deficits in visual-spatial abilities (medium to large effect sizes) but not in visual closure perception. Tests reporting broad visual perceptive indices showed inconclusive results. In addition, impaired visual-motor integration was found (medium effect size), particularly in boys compared to girls. The observed visual-spatial and visual-motor integration deficits may arise from affected occipital-parietal-frontal neural circuitries.     

Parenting stress in families with very low birth weight preterm infants in early infancy

Taking care of a premature infant adds an extra burden to already stressed parents. Previous studies have shown that parental stress occurs during the initial hospitalization. However, there is little information on parental stress over time, and the few existing results are conflicting. In addition, many studies have focused on maternal stress but there is little information about a father's long-term adaptation to stress. The purpose of this study was to examine the degree and type of parenting stress in the families of very low birth weight (VLBW) preterm infants over the first two years of life. We compared parenting stress in families with preterm infants with control families, while also comparing the stress in mothers to that in fathers. Furthermore, we explored the relationship between parenting stress in the preterm group with identified factors that included the infant's age, medical complications, and parents’ perceived feeding issues after they had been discharged from the hospital. This was an exploratory study with a cross sectional design. Participants included a total of 505 mothers from Tainan, Taiwan; 297 with preterm children (239 mothers, 58 fathers) and 208 with full-term children (181 mothers, 27 fathers). Assessments including the Parenting Stress Index, Neonatal Medical Index and Behavior-based Feeding Questionnaire were used to measure parental distress, infants’ medical complications and parents’ perceived feeding issues, respectively. Results of the study, though not statistically significant, indicated the presence of increased parenting stress in parents of preterm infants as compared to parents of full-term infants. 13.1% of mothers with preterm infants demonstrated total stress levels that warranted clinical intervention. We also found that mothers of preterm infants presented different parenting stress patterns than fathers of preterm infants. Fathers of preterm infants tended to have overall higher stress scores than mothers. On the other hand, mothers of preterm infants tended to report more health related difficulties, more depression, higher social isolation and role restriction, and less support from their spouses, than reported by fathers. Moreover, as time went on, parents with preterm infants continued to experience greater parenting stress than those with full-term infants. Understanding the experiences of parents with preterm children is important for health care providers while interviewing parents for information regarding their children and designing intervention programs to improve children's outcomes.     

Use of external drainage for posthemorrhagic hydrocephalus in very low birth weight premature infants

To treat progressive posthemorrhagic hydrocephalus we used early external ventricular drainage (EVD) in 14 premature infants. We think it is important that the catheters in these critically ill infants be inserted in the neonatal intensive care unit, allowing us to keep the infants in an extremely stable environment. Only after prolonged external ventricular drainage (on average 38.4 days) is a ventriculoperitoneal shunt considered, preferably when the child has reached a body weight of 2000 g. There were no infections or other severe drainage-related problems. We report mean daily EVD volumes (which are related to body weight) and EVD duration. The 14 patients included 9 who required permanent shunting. Comparing the mortality, morbidity and follow-up data to at least 3 months of age in this group with similar data for an earlier cohort treated with lumbar punctures and late permanent shunting, we demonstrate the safety of the policy we have recently adopted. Received: 8 January 1997     

Altered functional connectivity during face processing in children born with very low birth weight

Structural brain alterations have been reported in key emotional face processing regions following preterm birth; however, few studies have investigated the functional networks underlying these processes in children born with very low birth weight (VLBW). Using magnetoencephalography (MEG), we examined the functional networks related to the implicit processing of happy and angry faces in 5-year-old VLBW (n = 28) and full-term (FT; n = 24) children. We found that VLBW children showed atypical recruitment of emotional face processing networks in theta (4–7 Hz) compared to FT children. VLBW children showed reduced theta connectivity during processing of angry faces only. This hypo-connected theta-band network was anchored in the left orbitofrontal and parietal regions, involved in the higher level processing of faces and emotion regulation. At the behavioural level, despite VLBW children performing within the normal range, FT children had significantly higher affect recognition scores. Our MEG results suggest a selective impairment in processing angry faces, which would negatively impact social functioning in VLBW children. In FT children, greater recruitment of this theta-band network was positively associated with improved affect recognition scores. Thus, our findings suggest an important role of theta oscillations in early face processing, deficits which may contribute to broader socio-emotional impairments in VLBW children.