The early development of head control in preterm infants

This study documents the longitudinal development of head control in 104 infants born at 25-33 weeks gestation. Protective side turning of the head was found to have a developmental sequence of reducing spinal extension. In the 93 infants with normal motor outcome, individual differences in the rate of development correlated with caudo-cephalic muscle development (P less than 0.001, r = 0.5) but not with the length of extra-uterine experience. As a group, the 11 infants with later motor handicap showed a persistence of the early form of movement at 35-39 weeks post-menstrual age, without a significant correlation with the ratio of upper-lower limb muscle development. Head control, supine to sitting, in the infants with normal motor outcome showed variations in the rate of preterm development. The infants born at less than 31 weeks showed significantly higher scores at 33-35 weeks post-menstrual age than those born at 31-33 weeks (P less than 0.01). There was no difference at later ages. The spinal extension movement accompanying protective side turning of the head is age specific to the preterm infant. Individual rates of normal preterm development can be evaluated by longitudinal standardised examination. As a group, the infants with subsequent abnormal motor development showed delay at preterm age but this was not individually significant.     

应用近红外光谱技术评价早产儿认知功能的探讨

目的：通过建立对早产儿光刺激后的反应模式,评价早产儿早期的认知功能,研究早产儿在发育过程中的脑反应性与足月儿之间的差距。方法：对纠正胎龄3个月、6个月的早产儿进行光刺激,应用近红外光谱技术,观察光刺激后脑反应性的变化,并与同龄儿对照。结果：早产儿在纠正胎龄3个月时,光刺激后开始反应时间、反应高峰出现的时间分别为17.2±5.2s、38.4±9.6s,明显长于足月儿的13.1±2.7s、28.9±5.0s;脑组织还原血红蛋白、氧合血红蛋白、脑组织氧饱和度在刺激后的最大反应值分别为(1.2±0.5)%、(1.5±0.6)%、(1.3±0.4)%,明显低于足月儿的(2.3±0.3)%、(2.8±0.3)%、(2.4±0.5)%。到了纠正胎龄6个月时,光刺激后的脑反应性与足月儿相比,无统计学差异。结论：早产儿在发育过程中,认知功能存在一定的滞后,到纠正胎龄3个月时,外界刺激后的脑反应性仍落后于同龄儿,到了纠正胎龄6个月时,脑反应性接近同龄儿,应加强对早产儿的早期干预。     

Effects of early rehabilitative treatment on neurological development and cognitive and perceptual-motor functions of preterm infants at risk]

Longterm effects of early rehabilitative treatment are evaluated in 37 premature infants at neurological risk. The late neurological and psychomotor development of this group of children (experimental group) is compared with that of another 35 at risk premature infants (control group), who received only conventional follow-up care. The two groups do not differ in birth-weight, gestational age, sex and neonatal disorders. At 6 years of age the children of the experimental group have a significantly better neurological status and score higher than the control group, on mean mental indices. They also have lower incidence of neurodevelopmental sequelae (learning disabilities and behaviour problems). However children both in the experimental group and the control group have poor visual-motor integration. Similar results are found also in children, who were low-risk premature infants and who have normal intelligence. Our data suggest that a prescribed early rehabilitative treatment for high-risk preterm infants appears enhance the quality of late development. Treated children have the greatest improvement in all measured outcomes at 6 years (included neurological status, motor and overall development), but do not achieve the same level of neurological and behavioral development as full-term control children. One might question whether the latter finding indicate limited efficacy of early treatment or rather the need to consider separate series of norms for the preterm infant in assessing its outcome. This question requires additional follow-up studies.     

Low birth weight and home intervention strategies: preterm infants

We investigated the effects of a 1-year home intervention on premature infants with low (less than 1500 g) and higher (1500-2000 g) birth weights. Infants from each weight condition were block randomly assigned to a control or to one of two treatment groups. One treatment group focused on the development of the infant; the other treatment group focused on the parent-infant interaction. The low birth weight infants obtained significantly lower Bayley mental and motor scores, and were more passive and less intense than the higher birth weight infants. However, the low birth weight infants and their parents were more responsive to the home intervention than were the higher birth weight infants, as demonstrated by changes in the Bayley mental scores and the Home Observation for Measurement of the Environment (HOME) inventory. These findings exemplify the reciprocal relationship between the child's characteristics and parental responding. The importance of selecting the most high-risk premature infants for early home intervention is outlined.     

Longitudinal cognitive assessment in healthy late preterm infants

BackgroundLongitudinal cognitive development in late preterm (LP) infants has not been previously evaluated, using structured assessments.AimTo assess longitudinally cognitive development in a population of healthy LP infants from 12 months to preschool age.MethodsSixty-two low-risk LP infants (33–36 weeks gestation) with normal or only minor findings on their cranial ultrasound scans were included in the study. They were assessed at 12 and 18 months corrected age using the Bayley Scales of Infant Development II to obtain the mental development index (MDI) and then at preschool age (mean age 62 ± 7 months) using the Wechsler Preschool and Primary Scale of Intelligence (WPPSI-R).ResultsThe MDI scores obtained at both 12 and 18 months corrected age were within the reported normative range. Using uncorrected ages, their scores were lower at both ages than those obtained using CA (p < 0.01). Full-scale IQ scores within the reported normal range were obtained at 5 years using the WPPSI-R for all but 6 children.Females had significantly higher scores than males (p < 0.001) for the MDI at both 12 and 18 months corrected and uncorrected age. No gender differences were found at preschool age using the WPPSI-R.ConclusionsOur results suggest that over 90% of the low-risk late preterms reach an MDI and IQ at preschool age within normal range.     

无明显脑损伤早产儿早期口腔吸吮模式与6月龄时神经发育结局相关性研究

目的 对无明显脑损伤早产儿早期口腔吸吮模式与6月龄时神经发育结局行相关性分析,为早产儿早期神经干预提供依据。方法 纳入2013年10月至2015年4月重庆医科大学附属儿童医院住院的、无明显脑损伤的、胎龄>28周的早产儿。以新生儿口腔运动评估量表（NOMAS）作为诊断工具用于早产儿吸吮问题的评估。通过直接或间接（录像）方法观察早产儿的进食行为,根据吸吮过程中舌、颊的运动和节律等28个条目的评估,分为吸吮模式正常、紊乱和障碍。在矫正年龄6月龄时完成贝利婴幼儿发展量表（BSID）的测试,于BSID测试当日行体格测量。结果 128例无明显脑损伤早产儿进入本文分析,BSID随访时平均矫正年龄（6.2±0.5）个月。口腔运动正常和异常组分别为73例和55例,两组基线情况差异均无统计学意义（P均＞0.05）。口腔运动正常组智力发展指数（MDI）和精神运动发育指数（PDI）均高于口腔运动异常组,差异均有统计学意义（P均＜0.05）。NOMAS条目吸吮-吞咽-呼吸不协调与婴儿早期的不利神经发育结局显著相关（RR=3.53,95%CI:1.48～8.42）。结论 无明显脑损伤早产儿的早期正常口腔吸吮模式与6月龄时神经发育结局有明显相关性,但异常吸吮模式对神经发育延迟的预测意义有待进一步随访研究,吸吮-吞咽-呼吸不协调可能预示不利的神经发育结局。     

The early feeding skills assessment for preterm infants

Preterm infants develop the skills necessary to begin oral feeding as their health stabilizes and as they reach a postconceptional age that supports coordination of breathing and swallowing with oral-motor functioning. The time from initiation of oral feeding to full oral feedings (with adequate intake for growth and maintenance of physiologic stability) can vary from days to months for the preterm infant. The approach to feeding the infant during this transition period must be developmentally supportive and tailored to meet the needs of the individual. To accomplish this, caregivers--notably nurses and parents--need to communicate about the specific skills that the infant has gained, about skills that are emerging, and about skills that the infant has not yet developed. The Early Feeding Skills (EFS) Assessment is a checklist for assessing infant readiness for and tolerance of feeding and for profiling the infant's developmental stage regarding specific feeding skills: the abilities to remain engaged in feeding, organize oral-motor functioning, coordinate swallowing with breathing, and maintain physiologic stability. This article introduces the EFS.     

Eczema and early solid feeding in preterm infants

Aims: To establish whether development of eczema is influenced by feeding practices in preterm infants, while taking account of confounding factors. Methods: Data were assembled from 257 infants born prematurely and studied to 12 months post-term. Logistic regression analysis was performed to establish the association between feeding practices and eczema, allowing for potential confounding factors including the infants'' gender, parental atopic status, social background, and parental smoking habits. Results: For the development of eczema (with or without other symptoms) by 12 months post-term, the introduction of four or more solid foods by or before 17 weeks post-term was a significant risk (odds ratio 3.49). Male infants were at significantly higher risk (odds ratio 1.84). In addition, having non-atopic parents who introduced solid foods before 10 weeks post-term or having at least one atopic parent represented a significant risk scenario (odds ratio 2.94). Conclusions: Early introduction of a diverse range of solid foods may predispose the preterm infant to eczema development by 12 months post-term. Furthermore, non-atopic parents who practice early as opposed to late introduction of solid foods may be exposing preterm infants to a greater risk of eczema by 12 months post-term.     

Growth patterns in preterm infants born appropriate for gestational age

Aim:   This study aimed to document the growth patterns of a contemporary cohort of preterm infants born appropriate for gestational age (AGA). It was hypothesised that preterm AGA (PT-AGA) infants would display poorer growth than full-term AGA (FT-AGA) infants.
Methods:   Sixty-four PT-AGA infants and 64 FT-AGA infants were assessed at 0, 4, 8 and 12 months of corrected age (CA). Measurements of weight and length were recorded at each of the specified ages. Centers for Disease Control and Prevention growth data were used to calculate Z-scores for weight and length based on CA.
Results:   The mean length and weight Z-scores of PT-AGA infants were found to be significantly less than those of FT-AGA infants at term, 4, 8 and 12 months of CA ( P  < 0.001). The mean weight Z-score of PT-AGA infants was found to be less than their mean length Z-score at each time point, though the differences were not significant.
Conclusions:   The results of this study suggest that PT-AGA infants are likely to display poorer growth than FT-AGA infants until at least 1 year of CA. Long-term growth monitoring in this population is recommended.     

Cingulate sulcus development in preterm infants

Cranial ultrasounds performed during the first 3 d of life on 211 infants of 24 to 40 wk gestational age were examined to determine the in utero development of the cingulate sulcus. The sulcus was identified between 24 and 28 wk of gestational age as fragmented echoes in the region between the thalamus and the anterior fontanelle. Over the next several weeks, these fragments coalesced into a single linear echo. Branches then appeared off of the primary cingulate sulcus, increasing in number until a complex pattern of branching was noted near term gestation. This maturational sequence was similar to postnatal cortical development determined from serial ultrasounds performed on 144 infants who were less than or equal to 32 wk of gestational age at birth. The timing of postconceptional cingulate sulcus development was independent of gestational age at birth. However, severe brain insult, defined as intraventricular hemorrhage complicated by ventriculomegaly or intraparenchymal extension or periventricular leukomalacia, was associated with significant delays in all stages of cingulate sulcus development. Cranial ultrasound examinations in preterm infants allow a noninvasive means of staging qualitative brain development during the early postnatal period.