Relation of arterial stiffness with gestational age and birth weight.

BACKGROUND: The cardiovascular risk of individuals who are born small as a result of prematurity remains controversial. Given the previous findings of stiffer peripheral conduit arteries in growth restricted donor twins in twin-twin transfusion syndrome regardless of gestational age, we hypothesised that among children born preterm, only those with intrauterine growth retardation are predisposed to an increase in cardiovascular risks. AIM: To compare brachioradial arterial stiffness and systemic blood pressure (BP) among children born preterm and small for gestational age (group 1, n = 15), those born preterm but having birth weight appropriate for gestational age (group 2, n = 36), and those born at term with birth weight appropriate for gestational age (group 3, n = 35). METHODS: Systemic BP was measured by an automated device (Dinamap), while stiffness of the brachioradial arterial segment was assessed by measuring pulse wave velocity (PWV). The birth weight was adjusted for gestational age and expressed as a z score for analysis. RESULTS: The 86 children were studied at a mean (SD) age of 8.2 (1.7) years. Subjects from group 1, who were born at 32.3 (2.0) weeks' gestation had a significantly lower z score of birth weight (-2.29 (0.63), p<0.001), compared with those from groups 2 and 3. They had a significantly higher mean blood pressure (p<0.001) and their diastolic blood pressure also tended to be higher (p = 0.07). Likewise, their brachioradial PWV, and hence arterial stiffness, was the highest of the three groups (p<0.001). While subjects from group 2 were similarly born preterm, their PWV was not significantly different from that of group 3 subjects (p = 1.00) and likewise their z score of birth weight did not differ (-0.01 (0.71) v -0.04 (1.1), p = 1.00). Brachioradial PWV correlated significantly with systolic (r = 0.31, p = 0.004), diastolic (r = 0.38, p<0.001), and mean (0.47, p<0.001) BP, and with z score of birth weight (r = -0.43, p<0.001). Multiple linear regression identified mean BP and z score of birth weight as significant determinants of PWV. CONCLUSION: The findings of the present study support the hypothesis that among children born preterm, only those with intrauterine growth retardation are disadvantaged as a result of increase in systemic arterial stiffness and mean blood pressure.     

Relation of arterial stiffness with gestational age and birth weight

Background: The cardiovascular risk of individuals who are born small as a result of prematurity remains controversial. Given the previous findings of stiffer peripheral conduit arteries in growth restricted donor twins in twin–twin transfusion syndrome regardless of gestational age, we hypothesised that among children born preterm, only those with intrauterine growth retardation are predisposed to an increase in cardiovascular risks. Aim: To compare brachioradial arterial stiffness and systemic blood pressure (BP) among children born preterm and small for gestational age (group 1, n = 15), those born preterm but having birth weight appropriate for gestational age (group 2, n = 36), and those born at term with birth weight appropriate for gestational age (group 3, n = 35). Methods: Systemic BP was measured by an automated device (Dinamap), while stiffness of the brachioradial arterial segment was assessed by measuring pulse wave velocity (PWV). The birth weight was adjusted for gestational age and expressed as a z score for analysis. Results: The 86 children were studied at a mean (SD) age of 8.2 (1.7) years. Subjects from group 1, who were born at 32.3 (2.0) weeks'' gestation had a significantly lower z score of birth weight (-2.29 (0.63), p<0.001), compared with those from groups 2 and 3. They had a significantly higher mean blood pressure (p<0.001) and their diastolic blood pressure also tended to be higher (p = 0.07). Likewise, their brachioradial PWV, and hence arterial stiffness, was the highest of the three groups (p<0.001). While subjects from group 2 were similarly born preterm, their PWV was not significantly different from that of group 3 subjects (p = 1.00) and likewise their z score of birth weight did not differ (-0.01 (0.71) v -0.04 (1.1), p = 1.00). Brachioradial PWV correlated significantly with systolic (r = 0.31, p = 0.004), diastolic (r = 0.38, p<0.001), and mean (0.47, p<0.001) BP, and with z score of birth weight (r = -0.43, p<0.001). Multiple linear regression identified mean BP and z score of birth weight as significant determinants of PWV. Conclusion: The findings of the present study support the hypothesis that among children born preterm, only those with intrauterine growth retardation are disadvantaged as a result of increase in systemic arterial stiffness and mean blood pressure.     

Gestational age, birth weight, and the risk of hyperkinetic disorder.

AIMS: To study the association between gestational age and birth weight and the risk of clinically verified hyperkinetic disorder. METHODS: Nested case-control study of 834 cases and 20 100 controls with incidence density sampling. RESULTS: Compared with children born at term, children born with gestational ages of 34-36 completed weeks had a 70% increased risk of hyperkinetic disorder (rate ratio (RR) 1.7, 95% confidence interval (CI) 1.2 to 2.5). Children with gestational ages below 34 completed weeks had an almost threefold increased risk (RR 2.7, 95% CI 1.8 to 4.1). Children born at term with birth weights of 1500-2499 g had a 90% increased risk of hyperkinetic disorder (RR 1.9, 95% CI 1.2 to 2.9), and children with birth weights of 2500-2999 g had a 50% increased risk (RR 1.5, 95% CI 1.2 to 1.8) compared with children born at term with birth weights above 2999 g. The results were adjusted for socioeconomic status of the parents, family history of psychiatric disorders, conduct disorders, comorbidity, and maternal smoking during pregnancy. Results related to birth weight were unchanged after adjusting for differences in gestational age. CONCLUSIONS: Children born preterm, also close to term, and children born at term with low birth weights (1500-2499 g) have an increased risk of clinically verified hyperkinetic disorder. These findings have important public health perspectives because the majority of preterm babies are born close to term.     

Regional fat distribution in children born preterm evaluated at school age

Children born preterm may have aberrant adiposity. At school age, we evaluated body fat and fat distribution in 45 former preterm infants (birth weight < or = 1800 g and gestational age < 34 weeks) and 40 children born at term using dual-energy x-ray absorptiometry. Children born preterm exhibited lower total body fat mass and total body fat mass index compared with children born at term. Fat mass indexes in the limbs but not the trunk were lower in children born preterm than in children born at term. In conclusion, children born preterm, evaluated at school age, may be at risk for altered regional adiposity.     

Lung function in children born after foetal growth restriction and very preterm birth

Aims: To assess lung function at early school age in children delivered at very early gestation owing to intrauterine growth restriction and abnormal foetal blood flow (IUGR). Methods: Spirometry was performed at median age 8.4 (range 6.5–10.7) years in 31 children born preterm with IUGR (PT‐IUGR) with a median (range) birth weight (BW) of 650 (395–976) g and median (range) gestational age 27 (24–29) weeks. Control groups were matched for gender and age and had BW appropriate for gestational age (AGA); 31 children born preterm (PT‐AGA) with BW of 1010 (660–1790) g matched for gestational age at birth, and 31 children born at term (T‐AGA) with BW of 3530 (3000–4390) g. Results: The PT‐IUGR group had lower mean (SD) values of z‐scores for FEV₁, FEV₁/FVC and forced mid‐expiratory flow rate (FEF_25–75%) compared to the T‐AGA group, p = 0.003, p = 0.032 and p < 0.001, respectively, but did not differ from the PT‐AGA group. PT‐IUGR children delivered at ≥26 gestational weeks (GW) had lower FEF_25–75% than PT‐AGA children of corresponding GA, p = 0.014. Conclusion: Lung function was reduced in the PT‐IUGR group at early school age compared to controls born at term. The influence of IUGR on later lung function was only apparent in children born preterm after 26 GW.     

Die neurologische und kognitive Entwicklung zu klein geborener Kinder

This article aims to provide an overview on the neurological and cognitive outcome of children who were “born too small”. We will discuss the neurodevelopmental prognosis of term born small for gestational age children, and for children born prematurely (appropriate and small for gestational age). The various underlying causes responsible for intrauterine growth retardation (IUGR) and significance for neurodevelopmental outcome will be discussed briefly. Neurodevelopmental outcome of term born children with IUGR due to intrauterine malnutrition and outcome of preterm born small for gestational age (SGA) as well as preterm born appropriate for gestational age (AGA) children will then be discussed in more detail. Children with IUGR represent a heterogeneous group regarding the underlying cause that is responsible for the growth retardation. Neurodevelopmental prognosis very much depends on the specific underlying cause. IUGR caused by intrauterine malnutrition is not necessarily associated with neurodevelopmental problems. However, results of several studies suggest that in term born children with IUGR mild neuromotor problems and lower full scale IQ is more frequent when compared with term born appropriate for gestational age children. Prematurely born children are at high risk for neurodevelopmental impairment. There is no difference in frequency of disabling impairments between AGA and SGA preterm children. However, in preterms with IUGR there seems to be a higher frequency of mild neuromotor problems and cognitive function seems to be poorer than in appropriate for gestational age preterms.     

Health status development in a cohort of preterm children

OBJECTIVE: To determine the impact of preterm birth on health status (HS) development at the ages of 5 and 10 years in a cohort of children born before term. SAMPLE: Six hundred eighty-eight children, born in 1983 with a gestational age of <32 weeks and a birth weight of <1500 g. DESIGN: Prospectively collected HS variables, obtained from the parents, were analyzed in a longitudinal perspective by using principal component analyses. RESULTS: One third of the sample had minor to severe HS problems at both ages of measurement. One third had problems on one assessment only. The remainder of the sample had no HS problems at either age. The analyses grouped the HS variables into 3 combinations. Problems in basic functioning, such as mobility or speech, decreased with age. Negative moods substantially increased, and concentration problems increased slightly. Specifically at risk were preterm born children with handicaps, boys, and children who were small for gestational age. CONCLUSION: According to the parents, one third of the cohort had no HS problems at either age. The pattern of HS problems of the preterm born children changed between 5 and 10 years of age.     

Cholesterol metabolism in 8 to 12-year-old children born preterm or at term

Studies in animals have indicated that cholesterol metabolism is susceptible to manipulation by diet and growth in early life. In humans, low birthweight has been associated with increased risk of coronary heart disease. AIM: To establish whether plasma lipids and indicators of cholesterol absorption, synthesis and breakdown differ in children born preterm and at term. METHODS: Plasma total cholesterol, high density lipoprotein (HDL) cholesterol, low density lipoprotein (LDL) cholesterol, triacylglycerols, apolipoprotein A1, apolipoprotein B, lathosterol (indicator of cholesterol synthesis), campesterol (indicator of cholesterol absorption), 7-alpha hydroxycholesterol (indicator of cholesterol breakdown) were measured in up to 407 children born preterm and 36 children born at term. RESULTS: Children born preterm had lower cholesterol synthesis (p = 0.002) and lower cholesterol breakdown (p < 0.001) than those born at term, but their plasma cholesterol concentration was not significantly different. After adjusting for current size, birthweight and gestational age were significantly related to plasma lathosterol and 7-alpha hydroxycholesterol. However, when both birthweight and gestational age were adjusted, only gestational age remained significant. There were no significant differences in plasma campesterol between the two groups. CONCLUSION: Being born preterm may have a long-term effect on cholesterol metabolism in children 8-12 y later. Those born prematurely had lower cholesterol synthesis and breakdown, but their plasma cholesterol concentration was similar at this age. These parameters need to be studied in older cohorts.     

Cognitive development and attention performances at school age of "normal" prematurely born children]

OBJECTIVE: A preterm birth can exert an influence on cognitive development. The aim of this study was to determine whether preterm birth may impact on attention executive processes, at school age, in children without neurological sequelae. DESIGN AND METHODS: Prematurely born children admitted in the level III NICU of the Maternité régionale of Nancy between 1992 and 1994, underwent at 8 to 10 years 8 subtests of the mental processing scales of the K-ABC, which assess process categories involved in learning. The children were also submitted to 3 tests that evaluate attention mechanisms efficiency (category fluency task, backward digits span, Tower of London). The controls were children born at term recruted in schools of the same area. RESULTS: The 124 children were born with birth weight appropriate for gestational age, and were in the school grades expected for their ages, in 3rd, 4rth, and 5fth grades. Fifty-three children were born at term, 29 were prematurely born (33-36 w), and 42 were very prematurely born (28-32 w). Birth term was significantly correlated (P < 0.001) with scores at sequential processing scale, at simultaneous processing scale and at the mental processing composite scale. At this scale, the children born at term obtained a median score of 112, the children prematurely born of 101, and the children very prematurely born of 98.5. For 40 third grade children (18 born at term, 10 prematurely born, and 12 very prematurely born), birth term was significantly correlated with performances at the 3 tests of attention. In all cases, preterm was inversely correlated with performances. CONCLUSION: The results are consistent with a lower efficiency in attention executive processes which may be related to the higher frequency of learning disabilities associated with prematurity.     

Preterm birth contributes to increased vascular resistance and higher blood pressure in adolescent girls

Preterm birth might induce permanent changes in vascular structure and function as well as in blood pressure. To elucidate this hypothesis and underlying mechanisms in girls born before term, the authors correlated neonatal data, including estradiol levels, with vascular function and structure and with blood pressure after puberty. In a case-control study design, 34 girls born before term and 32 gender- and age-matched control infants born at term were included. Pulse wave analysis was used to determine aortic pressure profiles and overall arterial compliance. Stiffness of the carotid artery and abdominal aorta was measured with ultrasonography. Pulse wave velocity in the forearm was measured with photoplethysmography. A laser Doppler technique was used to determine skin perfusion before and after transdermal delivery of acetylcholine, an endothelium-dependent vasodilator. It was found that preterm girls had significantly higher brachial and aortic blood pressure, a narrower but less stiff abdominal aorta, and lower peripheral skin blood flow than did control infants. Augmentation index, carotid stiffness, pulse wave velocity, endothelium-dependent vasodilatation, and heart rate were similar in the two groups. In the preterm group, blood pressure and vascular functions showed no association with intrauterine growth retardation or neonatal estradiol levels. In conclusion, preterm girls have higher blood pressure and an increased resistance in the vascular tree after puberty. These findings may have implications for future cardiovascular risk in the growing adult population surviving preterm birth.     

中国三城市25 254例不同出生胎龄儿童神经行为发育水平研究

目的 探讨出生胎龄对学龄前儿童神经行为发育水平的影响。方法 来自安徽马鞍山市、浙江台州市、江苏扬州市的25 254例学龄前儿童纳入研究。根据所纳入儿童的出生胎龄,分为早产儿组（2 760例,胎龄28~36⁺⁶周）、早期儿组（6 005例,胎龄37~38⁺⁶周）、完全足月儿组（16 489例,胎龄≥39周）。采用年龄与发育进程问卷对儿童进行神经行为发育水平的评估。结果 早产儿组的沟通、粗大运动、精细运动、解决问题和个人-社会等5个能区的神经行为得分较完全足月儿组低（均P < 0.05）;早产儿组沟通、粗大运动、精细运动、解决问题4个能区神经行为得分较早期儿组低（均P < 0.05）;早期儿组各能区的平均分值与完全足月儿组相比,差异无统计学意义（均P > 0.05）。多元线性回归分析显示,校正了性别、年龄、体重指数、父母亲教育程度等混杂因素后,胎龄与5个发育能区（沟通、粗大运动、精细运动、解决问题和个人-社会）的得分呈显著正相关（P < 0.01）。结论 出生为早产儿的儿童神经行为发育水平较出生为完全足月儿和早期儿的儿童低,而出生为早期儿的儿童神经行为发育水平与出生为完全足月儿的儿童无明显差异。胎龄是神经行为发育水平的独立影响因素。     

Intrauterine growth in children with cerebral palsy

The risk of cerebral palsy in connection with intrauterine growth retardation has been analysed in a case-control study. The case series comprised 519 children with cerebral palsy born in 1967-1982 in the west health-care region of Sweden and the control series 445 children born during the same years in the same region. The risk of cerebral palsy in small-for-gestational-age infants was significantly increased in term and moderately preterm infants. The highest proportion among infants with cerebral palsy born at term was found in tetraplegia, followed by diplegia and dyskinetic cerebral palsy. It was concluded that small for gestational age on the one hand reflects early prenatal brain damage, and on the other mediates prenatal risk factors compatible with foetal deprivation of supply and also potentiates adverse effects of birth asphyxia and neonatal hypoxia.     

Preterm birth and maternal smoking in pregnancy are strong risk factors for aortic narrowing in adolescence

AIM: Preterm transition from foetal to neonatal circulation might permanently alter aortic growth and development. To test this hypothesis, we measured aortic dimensions in adolescents born very preterm. METHODS: Eighty-six healthy 15-year-old subjects were studied; 45 born very preterm at an average gestational age of 28 weeks (birth weight < 1500 g) and 41 controls born at term. Using a pulse-gated Fiesta sequence on a 1.5T MR-scanner, 25 images were collected within the heart cycle at several levels of the descending aorta. End-diastolic cross-sectional areas were semi-automatically calculated using an active contour model. RESULTS: Subjects born preterm had narrower aortic lumen. The difference was 16% in the thoracic and 19% in the abdominal aorta after adjustment for body surface area and gender (p < 0.001). Maternal smoking in pregnancy was also found to be an independent risk factor for aortic narrowing in the offspring (difference 10%-13% throughout the aorta vs. offspring to nonsmoking mothers). Adolescents born preterm had higher systolic and diastolic blood pressures; however, blood pressures did not correlate with aortic size or maternal smoking during pregnancy. CONCLUSION: Very preterm birth and exposure to maternal smoking in foetal life are independent and strong risk factors for general aortic narrowing 15 years after birth.     

Growth of 519 Small for Gestational Age Infants during the First Two Years of Life

ABSTRACT. The physical growth of 519 small for gestational age infants (SGA), with a birth weight below the 10th percentile on our own growth curve, born in the region of University Central Hospital of Turku during the period June 1,1981-May 31, 1982, was studied. The study population consists of 4 517 term, appropriate for gestational age (AGA) infants, 488 term SGA infants, 320 preterm AGA infants and 31 preterm SGA infants. The degree of intrauterine growth retardation (IUGR) seemed to have an effect on physical growth in term SGA infants. Those term SGA infants with a low Ponderal Index (PI) (type II) were taller and had a larger head circumference at the age of 24 months than term SGA infants with adequate PI (type I). Among the preterm SGA infants the degree of IUGR seemed to have no effect on later growth. Smoking is still one of the main risk factors associated with poor intrauterine growth. In this study we also found that smoking has an effect on later growth; the children of smoking mothers were smaller than those of non-smoking mothers in the AGA group. Among the SGA infants the infants of non-smoking mothers were bigger than those of smoking mothers. This difference could be explained by other factors associated with SGA. We found that in spite of the catch-up growth during the first months, 26% of the severely SGA infants (birth weight below the 2.5th percentile) still had a weight below the 2.5th percentile at the age of 24 months.     

Differences in insulin resistance markers between children born small for gestational age or born preterm appropriate for gestational age

Aim: To evaluate the impact of prenatal or postnatal compromised environment on glucose homoeostasis in children born preterm and appropriate for gestational age or small for gestational age (SGA) at term. Method: Seventy-seven children (median 9.9 years, range 8.5–10) born at Karolinska Hospital were allocated to three groups: 21 subjects born before 30 weeks of gestational age (preterm), 26 SGA at term and 30 at term with appropriate birth weight (control). Anthropometric measurements were taken, and fasting blood samples for haemoglobin A1c, glucose, insulin, IGFBP-1, IGF-1 and lipid profile were taken. Glucose, insulin and IGFBP-1 samples were taken at 0, 30 and 120 min during an oral glucose tolerance test (OGTT). Results: Subjects born preterm or SGA were shorter and thinner compared with Controls. After adjustment for body mass index (BMI), the SGA group had higher basal insulin levels (p = 0.029), higher homoeostasis model assessment—insulin resistance (p = 0.012) and lower whole-body insulin sensitivity index (p = 0.007) than Controls. IGFBP-1 decrease during OGTT was attenuated in the Preterm group compared with the Control (p = 0.045) and SGA groups (p = 0.007). Conclusion: The higher fasting insulin level in the SGA children, adjusted for BMI, could indicate peripheral insulin resistance. Preterm born children had reduced suppression of IGFBP-1 during OGTT, suggesting hepatic insulin resistance.     

Psychiatric morbidity in two low birth weight groups assessed by diagnostic interview in young adulthood

Aim: To study the prevalence and characteristics of psychiatric symptoms and disorders in young adults born with low birth weight. Methods: At 20 years of age 44 very low birth weight (VLBW: birth weight ≤1500 g), 55 term born small for gestational age (SGA: birth weight <10th percentile) and 75 control subjects born 1986–1988 were assessed using the interview Schedule for Affective Disorders and Schizophrenia for School‐age children and Structured Clinical Interview for DSM‐IV Personality Disorders, Children’s Global Assessment Scale and Attention deficit hyperactivity disorder (ADHD) Rating Scale IV; self‐report and parent report. Results: Fourteen (33%) VLBW versus six (8%) control participants had a definite psychiatric disorder: OR = 5.6 (1.9–15.9). In the term SGA group, 14 (26%) had a disorder: OR = 3.9 (1.4–11.0) vs controls. Anxiety disorders and ADHD were the most frequent diagnoses. The differences were not explained by gender, assessment age or parental socioeconomic status. ADHD Rating Scale mean scores were higher in parent reports in the VLBW group and in self‐reports in the term SGA group compared with the control group. Conclusion: Children born with low birth weight whether caused by preterm birth or by growth retardation at term seem to be at increased risk for psychiatric disorders as young adults.     

Underlying maternal and pregnancy‐related conditions account for a substantial proportion of neonatal morbidity in late preterm infants

Aim

We studied the impact of maternal and pregnancy‐related conditions and the effect of gestational age itself, on the health of infants born late preterm.

Methods

Singletons born in gestational weeks 34 + 0 to 41 + 6 in 1995–2013 in the southern region of Sweden were identified from a perinatal register. We found 14 030 infants born late preterm and 294 814 born at term. A hierarchical system was developed to examine the impact of pregnancy complications. The outcomes studied were as follows: neonatal death, central nervous system (CNS) or respiratory disease, infection, neonatal admission and respiratory support. Odds ratios (OR) and 95% confidence intervals (95% CI) were obtained using logistic regression analyses.

Results

Late preterm infants were at increased risk for all outcomes compared to term infants, with adjusted ORs from 13.1 (95% CI: 12.7–13.6) for neonatal admission to 2.3 (95% CI: 1.8–2.9) for infections. Late preterm birth after preterm prelabour rupture of membranes was associated with an overall lower risk compared to late preterm births due to other causes. Exposure to antepartum haemorrhage or maternal diabetes increased the risk for CNS and respiratory morbidity.

Conclusion

Morbidity decreased in late preterm infants with increasing gestational age. Underlying conditions accounted for a substantial part of the morbidity.     

Body measurements, neurological and behavioural development in six-year-old children born preterm and/or small-for-gestational-age

In three groups of low birth weight (LBW) infants: full term, small-for-gestational-age (FT-SGA, N = 142); preterm, appropriate-for-gestational-age (PT-AGA, N = 47); preterm, small-for-gestational-age (PT-SGA, N = 20); and a reference group of FT-AGA infants (N = 185) the relationship between body weight, body length and head circumference and the presence of minor neurological dysfunction (MND) was studied. Non-caucasian and handicapped children were excluded from the analysis. Data were collected on behaviour and school achievement. The parameters of physical growth in the three LBW groups were reduced significantly compared to the FT-AGA group. In both preterms and full-terms body measurements were related to weight at term age; in the preterm groups no relation with gestational age at birth was found. MND was not related to body weight or length. In the group of FT severely growth retarded infants a relation was found between a skull circumference below the third centile and the presence of MND. Body measurements, behaviour at home and at school and school achievement were not related. The significance of severe intrauterine growth retardation for developmental disorders is emphasized. The data suggest a different aetiology and clinical significance of small head size for AGA and SGA born children.     

Difference in mother-child interaction between preterm- and term-born preschoolers with and without disabilities

Aim: To investigate differences in the quality of mother–child interaction between preterm‐ and term‐born children at age 5, and to study the association of mother–child interaction with sociodemographic characteristics and child disability. Methods: Preterm children (n = 94), born at <30 weeks’ gestation and/or birth weight <1000 g, and term children (n = 84) were assessed at corrected age of 5 using a mother–child interaction observation. Disabilities were assessed using an intelligence test, behaviour questionnaires for parents and teachers, and motor and neurological examinations. Results: Mothers of preterm‐born children were less supportive of and more interfering with their children’s autonomy than mothers of term‐born children. This difference was only partly explained by sociodemographic factors. Dyads showed a lower quality of mother–child interaction if children had a severe disability, especially when mothers had a lower level of education. Conclusion: Five years after birth, mother–child interaction of very premature children and their mothers compared unfavourably with term children and their mothers. Mothers with sociodemographic disadvantages, raising a preterm child with severe disabilities, struggle most with giving adequate sensitive support for the autonomy development of their child. Focused specialized support for these at risk groups is warranted.     

Neurologic examination of preterm infants at term age: comparison with term infants

OBJECTIVES: The aim was to establish the range of neurologic findings in preterm infants reaching term age, their relation to gestational age at birth, and the possible differences with healthy term newborns tested during the first days of life. STUDY DESIGN: The Dubowitz neonatal neurologic examination was performed at term age in 157 low-risk preterm infants born between 25 and 34 weeks' gestation who had cranial ultrasonograms that were normal or showed minor abnormalities. Infants were subdivided in 3 groups according to their gestational age at birth. RESULTS: Within the preterm cohort, the range of scores for the 3 gestational age subgroups was different from each other for 21 of the 34 items, although the median scores were different only in 10 of the 34 items. The range of scores and their median in preterm infants however was wider than that found in term infants. Preterm infants examined at term were also more hyperexcitable and tended to have less flexor tone in the limbs and less extensor tone in the neck in the sitting posture. CONCLUSIONS: The distribution of scores provides useful guidelines when a preterm infant is examined at term.