Attention problems in a representative sample of extremely preterm/extremely low birth weight children

The aim of this study was to examine attention in a large, representative, contemporary cohort of children born extremely preterm (EP) and/or extremely low birth weight (ELBW). Participants included 189 of 201 surviving children born EP (<28 weeks' gestation) or ELBW (<1,000 g) in 1997 in the state of Victoria, Australia. A comparison group of 173 of 199 children born full term and normal birth weight (FT/NBW) were randomly selected matching for birth hospital, expected due date, gender, mother's country of birth, and health insurance status. Participants were assessed at 8 years of age on subtests from the Test of Everyday Attention for Children (TEA-Ch) and the Wechsler Intelligence Scale for Children-4th Edition (WISC-IV). Measures of selective attention, sustained attention, attention encoding, and executive attention (inhibition, shifting attention, and divided attention) were administered. To assess behavioral elements of inattention, the primary caregiver completed the Behavior Rating Inventory of Executive Function (BRIEF) and the Conners' ADHD/DSM-IV Scale (CADS-P). The EP/ELBW group performed more poorly across all cognitive and behavioral measures than the FT/NBW group, with the exception of inhibition. The EP/ELBW group also had significantly elevated rates of impairment in selective, sustained, shifting and divided attention, as well as attention deficit hyperactivity disorder (ADHD) symptoms. No significant gender or gradient effects (e.g., <26 weeks' gestation vs. ≥ 26 weeks' gestation) were identified. Neonatal medical factors were not strong predictors of attention, although necrotizing enterocolitis (NEC) and cystic periventricular leukomalacia (PVL) were independent predictors of selective attention. In conclusion, our comprehensive assessment of attention provides strong evidence that children born EP/ELBW are at increased risk for attentional impairments, and as such, this population should be monitored closely during early and middle childhood with a focus on attention functioning.     

Intraocular pressure in very low birth weight preterm infants and its association with postconceptional age

OBJECTIVE:

To evaluate intraocular pressure in very low birth weight preterm infants and correlate it with postconceptional age.

METHODS:

The intraocular pressure in a prospective cohort of very low birth weight premature infants (defined as a birth weight ≤1,500 g and gestational age ≤32 weeks) admitted to Hospital de Clínicas de Porto Alegre, Brazil was evaluated weekly. The evaluated outcome was the variation in the intraocular pressure following changes in the postconceptional age (defined as the gestational age at birth plus the age in weeks at the time of examination) in the weeks following preterm birth. Mixed-effects models were used for the statistical analysis to determine the intraocular pressure variation according to postconceptional age, and means and 10^th and 90^th percentiles were calculated for the intraocular pressure values.

RESULTS:

Fifty preterm infants with a mean gestational age of 29.7±1.6 weeks and a mean birth weight of 1,127.7±222.7 g were evaluated. The mean intraocular pressure for the entire cohort considering both eyes was 14.9±4.5 mmHg, and 13.5% of all recorded intraocular pressure values were greater than 20 mmHg. The analysis revealed a mean reduction in the intraocular pressure of 0.29 mmHg for each increase in postconceptional age (p = 0.047; 95% CI: −0.58 to −0.0035). The mean intraocular pressure (P10–P90) decreased from 16.3 mmHg (10.52–22.16) at 26.3 weeks to 13.1 mmHg (7.28–18.92) at 37.6 weeks of postconceptional age.

CONCLUSIONS:

The mean intraocular pressure in very low birth weight preterm infants was 14.9±4.5 mmHg. This value decreased 0.29 mmHg per week as the postconceptional age increased.     

Cognition,behavior and social competence of preterm low birth weight children at school age

OBJECTIVE:

The aim of this study was to assess the cognitive and behavioral development of preterm and low birth weight newborns living in a disadvantageous socioeconomic environment at school age.

METHODS:

This cross-sectional study included children aged 6-7 from a historical birth cohort of preterm (gestational age <37 weeks) and low birth weight (<2,500 g) infants. The Wechsler Intelligence Scale for Children III (WISC-III) was administered by a psychologist while the parents completed the Child Behavior Checklist. The results were compared to the test''s reference. The perinatal information and follow-up data were collected from the hospital files. The demographic data were collected from the parents. The current performance was compared with the results from the Denver II and Bayley II tests, which were administered during the first years of life.

RESULTS:

The total intelligence quotient varied from 70 to 140 (mean 98.7±15.8). The borderline intelligence quotient was observed in 9.3% of the children. The Child Behavior Checklist indicated a predominance of social competence problems (27.8%, CI 19.2 to 37.9) compared with behavioral problems (15.5%, CI 8.9 to 24.2). Both the Child Behavior Checklist domains, such as schooling, social and attention problems, and the cognitive scores were significantly associated with maternal education and family income. The results of the Denver and Bayley tests were associated with the cognitive performance (p<0.001) and the Child Behavior Checklist social profile, including aggressive and externalizing behavior (p<0.001).

CONCLUSIONS:

Our data suggest that even low-risk preterm newborns are at risk for developing disturbances in early school age, such as mild cognitive deficits and behavioral disorders. This risk might increase under unfavorable socioeconomic conditions.     

早产儿及低体重儿四种支原体感染状况研究

为了解早产儿、低体重儿人型支原体 (Mh)、解脲脲原体 (Uu)、生殖支原体 (Mg) ,发酵支原体 (Mf)等 4种支原体的感染状况 ,我们于 1997年～ 1998年分别收集了 2 7例早产儿和 2 1例低体重儿的咽拭子标本应用套式PCR (nPCR)法进行上述 4种支原体特异性核酸检测。结果早产儿和低体重儿的Mh阳性率分别为 92 6 %、95 2 % ;Uu阳性率分别为 5 5 5 %、38 1%。Mh Uu合并感染状况严重 ,分别为 5 5 5 %、33 3%。Mg只有 1例阳性 ,Mf无阳性病例发现。无论是早产儿 ,还是低体重儿 ,剖宫产与阴道产的各种支原体检出率无差别 (P均 <0 0 5 )。剖宫产娩出儿咽部查出支原体可确认为宫内感染 ,由此可见 ,支原体宫内感染状况严重。本文并就支原体感染与早产和新生儿出生低体重的发生原因进行了讨论。     

Assessment of developmental coordination disorder in children born with extremely low birth weights

There is no tool that is considered the "gold" standard for identifying children with developmental coordination disorder (DCD) and various techniques have been reported in the research literature. The aim of this study was to examine the prevalence of DCD in a cohort of extremely low birth weight (ELBW; birth weight ≤ 1,000g) children at age 5 years using various methods including standardized motor assessment measures, an established clinic protocol, and a parent report. We also examined the association between selected neonatal risk factors and severity of the motor impairment. Four methods were used to assess motor functioning: (1) the Movement Assessment Battery for Children (Movement ABC); (2) a motor assessment battery, which included the Movement ABC, the Beery-Buktenica Developmental Test of Visual Motor Integration, and the Developmental Test of Visual Perception-2; (3) a Perinatal Follow-up Clinic protocol, which included the Geometric Design and the Mazes subtests of the Wechsler Preschool and Primary Scale of Intelligence-Revised, the Fine and Gross Motor subscales of the Child Development Inventory, and a pediatric neuromotor exam; and (4) a parent completed questionnaire (i.e., Developmental Coordination Disorder Questionnaire (DCDQ)). The prevalence of motor impairment in ELBW children was 64% on the Movement ABC, 67% on the motor assessment battery, 66% on the Perinatal Follow-up Clinic protocol, and 26% on the DCDQ. Sensitivity ranged from 36% to 100% and specificity from 65% to 92% using the Movement ABC as the reference standard. Neonatal risk factors associated with increased severity of motor impairment were bronchopulmonary dysplasia, postnatal steroids, and increasing gestational age. Children with birth weights ≤ 1,000 g are at considerable risk for motor impairment; therefore, developmental evaluations should include an assessment of motor functions. A standardized motor assessment test such as the Movement ABC appears to be the most effective and efficient means of identifying motor impairment in this high-risk population.     

Multimodal longitudinal respiratory function assessment in very low birth weight 7-year-old children

PurposePreterm birth is associated with adverse pulmonary outcomes. We aimed to evaluate respiratory morbidities and lung function of very low birth weight (VLBW) Polish children followed up at the age of 7 years old, and to compare with electrical impedance segmentography (EIS) results recorded at 4 years of age.Materials and methodsVLBW children were compared with term controls using impulse oscillometry and spirometry. Perinatal data and current respiratory morbidities were analyzed and pulmonary function test results were compared with previous EIS results.ResultsWe included 40 VLBW children and 30 controls in the analysis. Elevated total airway resistance and forced expiratory volume in the first second below the lower limit of normal were more prevalent in VLBW children compared with term controls (15 vs 0%; 18 vs 0%). A positive bronchodilator response was more common in VLBW children (R_{5 Hz}: 46 vs 13.3%; R_{5–20 ​Hz}: 65 vs 36.7%). Children with bronchopulmonary dysplasia (BPD) had higher total airway resistance (R_{5 Hz}/R_{5 Hz pred}: 1.35 vs 0.95; p ​< ​0.001), large airway resistance (R_{20 Hz}/R_{20 Hz pred}: 0.89 vs 0.66; p ​= ​0.001), small airway resistance (R_{5–20 ​Hz}: 0.57 vs 0.34 ​kPa ​L⁻¹ ​s⁻¹; p ​= ​0.009), than controls. Strong correlation between BDR in EIS and R_{5 Hz}/R_{5 Hz pred} was observed in children with BPD (r ​= ​0.7).ConclusionVLBW school-aged children with BPD presented with substantial respiratory morbidity and persistent reduction of lung function, affecting small and large airways and lung parenchyma. EIS may be an alternative tool for lung function assessment in children with BPD.     

Learning and behavioral--emotional problems of children born preterm at second grade.

A longitudinal prospective study examined the question, "which child and family factors discriminate between children born preterm who are characterized by the presence or absence of learning or behavioral-emotional problems at second grade?" Assessments were completed during the child's hospital stay at birth, at 4, 8, and 24 months, and 8 years of age for 68 children born preterm and their mothers. Discriminant analyses identified the variables that statistically maximized the differentiation between two groups of children defined to exhibit or not exhibit school age problems. Three categories of discriminators were used in the analyses: infant status, family interactive quality, and family context. The three significant discriminators were variables from the family categories. The results of this study highlight the importance of understanding the presence or absence of school age problems from a multivariate model of development that takes into account the quality of the child's interactions within the family during early childhood and school age and the current stress levels in the family context.     

Understanding language and cognitive deficits in very low birth weight children

Very-low-birth-weight infants are at much higher risk for cognitive and language delays but the nature of such deficits is not clearly understood. Given increasing rates of prematurity and infants born very-low-birth-weight, examination of mechanisms that underlie poorer developmental outcome is essential. We investigated language and cognitive abilities in very-low and normal birth-weight infants to determine whether performance differences were due to poorer global cognitive performance or to deficits in specific processing abilities. Thirty-two very-low and 32 normal birth-weight infants received visual and auditory-visual habituation recognition-memory tasks, and standardized language and cognitive assessments. Very-low-birth-weight infants performed more poorly on visual and auditory-visual habituation tasks and scored lower than controls on cognitive and language measures. These findings suggest that differences in language abilities in very-low-birth-weight children may be part of a global deficit that impacts many areas of cognitive functioning rather than a specific impairment in rapid auditory processing.     

Spatial working memory deficits in children at ages 3-4 who were low birth weight, preterm infants

The aim of this study was to investigate attention and perceptual and spatial working memory abilities in preterm, low birth weight preschool children without evident brain disorders as determined by normal cerebral ultrasound findings and normal motor development. The authors evaluated 19 preterm and 19 typically developing children who were matched for IQ and chronological age. Results indicated that children born prematurely without major neurological deficits and with a normal cognitive level may have specific difficulty in sustained attention, visuospatial processing, and spatial working memory when evaluated at ages 3-4. This finding is relevant for understanding the qualitative aspects of cognitive development in preterm children and the neurobiological substrate underlying this development.     

极低出生体重儿临床相关因素及与预后的关系

目的探讨极低出生体重儿的围产期及临床特点,分析其与预后的关系.方法分析110例极低出生体重儿(含12例超低出生体重儿)的一般情况、产科及母孕期情况、新生儿临床特点.结果胎龄小于32w者占79%,小于胎龄儿占17.3%,41%为多胎;32%有胎膜早破史,18%母亲有妊高征;36%有窒息复苏史;产科异常是胎儿早产的主要原因.呼吸暂停、低体温、高胆红素血症及低血糖是常见的并发症;多胎、围产期异常及小于胎龄儿是极低出生体重儿主要死亡原因,生于院内或转运者死亡率明显低于院外出生者(P<0.01).结论加强对高危孕妇及新生儿的监护,普及新生儿窒息复苏知识,将有助于改善极低出生体重儿的预后.     

Sleep quality in young adults with very low birth weight--the Helsinki study of very low birth weight adults

Objective To assess the relationship between very low birthweight (VLBW; <1,500 g) and quality and amount of sleep inyoung adults. Methods We compared 89 VLBW and 78 term-born19- to 26-year-old adults, by actigraphy and the Basic NordicSleep Questionnaire. Results There were no group differencesin sleep quality or amount (p's >.15), although VLBW adultswent to bed on average 36 min earlier (95% confidence interval6–66 min). Shorter gestational age was related to longersleep latency both within VLBW (standardized regression coefficientβ = –.36, p =.040) and term-born adults (β =–.25, p =.029). Conclusion Adults with VLBWhad similar quality and amount of sleep as those born at term,although VLBW adults went to bed earlier, suggesting an advancedsleep phase. Within each group, a lower gestational age wasrelated to a longer sleep onset.     

Attentional processes in children with ADHD: An event-related potential study using the attention network test

A variety of event-related potential (ERP) based studies have shown differences in neuronal processes underlying attention, inhibition and error processing in children with attention-deficit/hyperactivity disorder (ADHD) compared to controls. However, so far there are no studies that have compared children with ADHD and typically developing (TD) children regarding effects in ERP components associated with the attention network test (ANT). The ANT allows to differentiate between three particular aspects of attention: alerting, orienting, conflict.Twenty-five children with ADHD and 19 TD children (comparable with respect to age, sex, and IQ) performed the ANT while ERPs were recorded. Based on DSM-IV, the group of children with ADHD was divided in an inattentive (ADHDin, n = 10) and a combined (ADHDcom, n = 15) subgroup.On the performance level, the ADHD group showed a significantly higher variability of reaction times. Concerning ERP measures, smaller cue-P3 amplitudes were found in the ADHD group indicating that children with ADHD allocate less attentional resources for cue processing. In addition, the target-P3 in ADHD showed smaller amplitudes. Subgroup analysis revealed reduced cue-P3 amplitudes in both subgroups and reduced target-P3 amplitudes in ADHDin compared to TD children. Except for a higher alerting score in ADHD after correction for cue-P3 group differences, performance data revealed no group differences specific for the three attention networks. No group differences related to the attention networks were observed at the ERP level.Our results suggest that deviant attentional processing in children with ADHD is only partly related to ANT-specific effects. Findings are compatible with the model of a suboptimal energetic state regulation in ADHD. Furthermore, our results suggest that deviant cue processing in ADHD and related differences in task modulations should be accounted for in data analysis.     

IgG and IgA antibody levels to cow's milk are low at age 10 years in children born preterm

BACKGROUND: Both innate and specific defenses of the preterm infant are even less developed than those of term infants, and the immune systems of preterm infants might be skewed differently at birth. Their immune responses to food antigens started early in life might therefore differ from those of term infants. OBJECTIVE: We sought to compare antibody levels to cow's milk, ovalbumin, and gliadin at age 10 years in children who had been born either preterm or at term. METHODS: IgG and IgA isotype antibodies to whole cow's milk, beta-lactoglobulin, alpha-casein, and ovalbumin, as well as IgG antibody levels to gliadin and to tetanus and diphtheria toxoids, were measured for a group of 62 children born preterm and 61 control subjects born at term. These children were studied at the same time for atopy. RESULTS: Children born preterm had markedly lower levels of antibodies to cow's milk and to its protein fractions (P <.0001 for IgA and IgG antibodies to cow's milk and alpha-casein and IgG beta-lactoglobulin antibodies). IgG gliadin antibodies were also significantly lower in the preterm group (P =.03), although the difference was not significant for IgG ovalbumin antibodies. In the preterm group both those born before gestational week 30 and those given cow's milk-based formula early (before day 50) had the lowest levels of cow's milk antibodies. In the preterm group atopy was associated with low levels of IgG cow's milk antibodies but with high levels of IgG ovalbumin antibodies. CONCLUSIONS: Early introduction of food antigens into the immature gastrointestinal tract of preterm infants might result in tolerance. The presence of less atopy in these children might also be a result of tolerance development.     

The changes in the mortality rates of low birth weight infant and very low birth weight infant in Korea over the past 40 years

Total 36 reports on the mortality rates (MRs) of low birth weight infants (LBWI) and very LBWI (VLBWI) in Korea from the 1967 through 2001 were analyzed. We compared the changes in the MR by 5 and 10-yr interval. The MRs observed by 5-yr intervals from the early 1960s through the 1990s have drastically decreased. The MRs of LBWI are as follows: 23.1% and 23.6% in the 1960s, 17.3% and 16.8% in the 1970s, 14.1% and 14.4% in the 1980s, and 8.1% in the early 1990s. The MRs of VLBWI have also fallen and were reported as follows: 68.2% and 63.7% in the 1960s, 55.8% and 57.6% in the 1970s, 56.2% and 48.1% in the 1980s, 33.5% and 24.5% in the 1990s, and 11.7% in the early 2000s. In every 10-yr period, the MRs of LBWI have decreased from 23.4% in 1960, to 17.0% in 1970, to 14.2% in 1980, and to 8.1% in 1990. The MRs of VLBWI also have decreased from 66.2% in 1960, to 56.7% in 1970, to 50.8% in 1980, to 32.9% in 1990, and to 11.7% in 2000. The MR of LBWI and VLBWI has gone down remarkably due to improvements in neonatology in Korea as shown above.     

Nasal CPAP in the delivery room for newborns with extremely low birth weight in a hospital in a developing country

The objective of this study was to determine the feasibility of the use ofcontinuous positive airway pressure installed prophylactically in the deliveryroom (DR-CPAP), for infants with a birth weight between 500 and 1000 g insettings with limited resources. During 23 months, infants with a birth weightbetween 500 and 1000 g consecutively received DR-CPAP. A total of 33 infantswith low birth weight were enrolled, 16 (48.5%) were females. Only 14 (42.4%)received antenatal corticosteroids and only 2 of those 14 (14.3%) infantsweighing 500-750 g were not intubated in the delivery room, and apnea was givenas the reason for intubation of these patients. Of the 19 infants in the751-1000 g weight range, 9 (47.4%) were intubated in the delivery room, 6 due toapnea and 3 due to respiratory discomfort. For DR-CPAP to be successful, it isprobably necessary for preterm babies to be more prepared at birth to withstandthe respiratory effort without the need for intubation. Antenatalcorticosteroids and better prenatal monitoring are fundamental for success ofDR-CPAP.     

Brief report: birth status, medical complications, and social environment: individual differences in development of preterm, very low birth weight infants

OBJECTIVE: To assess whether medical complications mediate the relationship between birth status (i.e., birth weight and gestational age) and developmental outcome of preterm, very low birth weight (VLBW) infants, as well as the role of the early social environment (maternal distress and social support) in infant development. METHOD: Birth status and medical complication information was collected during the child's NICU stay. Maternal distress was assessed with the Beck Depression Inventory and the Parenting Stress Index at 4 months corrected infant age. Social support was measured with the Dunst Scales at 4 months corrected age. Child development measures were collected at 4 and 13 months corrected age (Bayley MDI and PDI), and at 36 months chronological age (PPVT-R and Achenbach CBCL). RESULTS: Medical complications mediated the birth status-outcome relationship at 4 and 13 months, but not at 36 months. The 36-month outcomes were predicted by 4-month maternal distress and social support. CONCLUSIONS: Prematurity and VLBW are indirectly related to early developmental outcome through their association with medical complications. However, by 36 months, developmental outcomes are more closely related to aspects of the early social environment than to early physiological factors.     

Diagnosis of Ureaplasma parvum meningitis by mNGS in an extremely low birth weight infant with multi-system lesions

Ureaplasma parvum encephalitis is a rare disease with high mortality in the neonates. While the manifestations are atypical and identification of U. parvum is difficult, diagnosis would always be delayed. Metagenomic next-generation sequencing (mNGS) is a pre-hypothesis free technique which could theoretically detect all the microbes in a sample. Herein we report a case of U. parvum meningitis identified by mNGS in an extremely low birth weight neonate complicated with multi-system lesions. The patient was treated with erythromycin and ciprofloxacin, symptoms were relieved in the following days and the patient was transferred to treat complications after three weeks' therapy.