Cerebral magnetic resonance imaging (MRI) of very low birth weight infants at one year of corrected age

Cerebral MRI was performed at 1.5 T in 27 infants with birth weight below 1500 grams at 1 year of corrected age. The images were compared to those reported on normal development at the same age. On T1 weighted images, 20 (74.1%) of the 27 infants showed myelin deposition different from what has been reported to be normal. Areas most affected were the central occipital white matter and the centrum semiovale. Both correspond to watershed areas known to be at risk for periventricular leukomalacia in preterm infants. T2-weighted images showed delayed myelination in the same areas as described for T1. In addition, two infants showed delayed myelination in the central occipital white matter and one in the centrum semiovale. Patchy focal abnormalities involving the white matter were seen in seven (25.9%) infants. Mild cerebral atrophy, mainly of the cortex was found in 10 (37.0%) infants. Irregular shape of the lateral ventricles, especially of the occipital horns was present in 12 infants (44.4%). 11 of these infants also had deviating changes in myelination. Only 2 infants (7.4%) had a normal MRI examination. Follow-up MRI examinations are needed to determine whether the high percentage of changes in myelination represent delayed development or brain damage in preterm infants.     

Exercise performance in very low birth weight children at the age of 7–12 years

Fifteen very low birth weight children, 9 appropriate for gestational age (AGA, mean birth weight 1302 ± 164 g) and 6 small for gestational age children (SGA, mean birth weight 1263±117 g), were studied at the age of 7–12 years, and compared to a group of 26 healthy, age-, sex-, and height-matched children born at term. None of the VLBW children had developed chronic bronchopulmonary disease. Pulmonary function tests and progressive exercise tests on a treadmill were performed. Forced vital capacity, forced expiratory volume at 1 s and forced expiratory flow between 25% and 75% of vital capacity were normal for all subjects. No differences were found in maximum oxygen consumption, anaerobic threshold and maximal heart rate between the AGA and SGA children and the respective controls. Both in the AGA and SGA subgroups, the pre-exercise oxygen uptake results were comparable to those of the controls. In the SGA subgroup the energy cost of running was significantly higher with respect to the controls, while no difference was found between the AGA and the control children. In conclusion, children with birth weight less than 1501 g have normal values of aerobic fitness. In SGA children the efficiency of running is slightly reduced.     

Visual-motor function of very low birth weight and full-term children at 3 1/2 to 4 years of age

Improvements in perinatal and neonatal management have not only led to a higher survival rate of very low birth weight infants (VLBW; < or = 1,500 g or < 32 weeks gestational age), but also to a better outcome of these children. However the percentage of VLBW children who need special education because of later school problems remains high even in children considered neurologically normal during infancy. We assessed 40 VLBW children and 83 healthy full-term children at age 3 to 4 years by means of a simple and short test for visual-motor deficits. The test included the copying and cutting-out of geometric shapes, the building of models, the recognition of colours and the observation of the concentration and cooperation during the test. All VLBW children had had a good perinatal outcome and had been considered neurologically normal at one year of age. Most VLBW children scored within 1 standard deviation (S.D.) of the test mean, but on average the VLBW children scored significantly lower than the full-term infants in the copying of figures, the cutting-out of geometric forms, the building of models and in the overall concentration and cooperation during the test. Children who attended a nursery school achieved significantly better test results. Girls tended to have better results, but this was not statistically significant. Social factors and age had a significantly greater impact on results than perinatal factors. In summary, VLBW children scored significantly less in almost every test item compared to their term peers. Our test battery could serve as a short introductory test to screen for deficits in visual-motor skills, especially in VLBW children.     

Parental protection of extremely low birth weight children at age 8 years

OBJECTIVE: To examine parent protection and its correlates among 8-year-old ELBW children compared with normal birth weight (NBW) controls. METHODS: The population included 217 eight-year-old ELBW children born 1992-1995 (92% of the surviving birth cohort; mean birth weight, 811 g; mean gestational age, 26.4 weeks) and 176 NBW controls. The primary outcome measure, the Parent Protection Scale (PPS), included a total score and four domains including Supervision, Separation, Dependence, and Control. Multivariate analyses were performed to examine the predictors of parental protection and overprotection. RESULTS: After adjusting for socioeconomic status (SES), race, sex, and age of the child, parents of ELBW children reported significantly higher mean total Parent Protection Scale scores (31.1 vs 29.7, p = .03) than parents of NBW children and higher scores on the subscale of Parent Control (8.0 vs 7.5, p = .04). These differences were not significant when the 36 children with neurosensory impairments were excluded. Parents of ELBW children also reported higher rates of overprotection than controls (10% vs 2%, p = .001), findings that remained significant even after excluding children with neurosensory impairments (8% vs 2%, p = .011). Multivariate analyses revealed lower SES to be associated with higher total Parent Protection Scale scores in both the ELBW (p < .001) and NBW (p < .05) groups. Additional correlates included neurosensory impairment (p < .05) and functional limitations (p < .001) in the ELBW group and black race (p < .05) and maternal depression (p < .01) in the NBW group. Lower child IQ was significantly associated with higher PPS scores only in the neurosensory impaired subgroup of ELBW children. CONCLUSIONS: Longer term follow-up will be necessary to examine the effects of the increased parent protection on the development of autonomy and interpersonal relationships as the children enter adolescence.     

Catch-up growth up to ten years of age in children born very preterm or with very low birth weight

Background  

Improved survival due to advances in neonatal care has brought issues such as postnatal growth and development more to the focus of our attention. Most studies report stunting in children born very preterm and/or small for gestational age. In this article we study the growth pattern of these children and aim to identify factors associated with postnatal catch-up growth.     

Academic achievement, behavioural outcomes and MRI findings at 15 years of age in very low birthweight children

Abstract Aim: To assess cognitive, academic and behavioural functions in 15-year-old very low birthweight (VLBW) children and relate results to gender, neonatal risk factors, growth and magnetic resonance imaging (MRI) findings. Methods: Sixty-one out of 86 VLBW children and 57/86 term controls born in the south-east region of Sweden were assessed regarding cognition (WISC III), school outcome, behaviour and growth. VLBW children were examined using cerebral MRI. Results: VLBW children performed significantly lower than their term controls on WISC III and 49% had IQ lower than 85. Ten VLBW children with IQ < 70 had not been clinically identified earlier and a majority of these children attended mainstream school. VLBW girls had significantly lower total problems scores. Using MRI, white matter damage (WMD) was detected in 16 (27%) children. VLBW boys with WMD had significantly lower IQ than those without. Small occipito-frontal circumference (OFC) correlated with low IQ. Mechanical ventilation and intraventricular haemorrhage (IVH) showed significant correlations with lower IQ and reading skills. Conclusion: VLBW children achieved poorer results compared with their controls in cognitive tests. Mechanical ventilation and IVH were related to poorer academic outcome. Many of the children with low IQ had not been identified earlier. Therefore, we recommend that VLBW children undergo an IQ test before beginning school in order to receive adequate support.     

Prediction of height achievement at five years of age in children born very preterm or with very low birth weight: continuation of catch-up growth after two years of age

To predict height at five years in a cohort of 565 very preterm and/or very low-birth-weight children, hypothesized growth determinants were subjected to discriminant analysis. Many neonatal parameters were not significantly associated with short stature at five years of age. A correct classification of stature (smaller/larger than the 10th percentile at five years of age) could be obtained in 85% of children, using the following variables: height at two years of age; total (or mid) parental height; parental level of education; length at one year of age; hypertension during pregnancy; sex; weight at two years of age; length percentile at one year of age. However, when compared to actual longitudinal data, the false-positive rate was 37%. The survey also demonstrated the continuing catch-up growth in very preterm and very low-birth-weight infants after two years of age.     

Massage therapy improves neurodevelopment outcome at two years corrected age for very low birth weight infants

Background

Long term effects of massage therapy in very preterm newborns infants are still to be described. Few studies evaluated neurodevelopment just at six months, and included late preterm infants.

Objective

To study the effect of massage therapy on neurodevelopment of very low birth weight infants at two years corrected age.

Study design

Newborns with birth weight between ≥ 750 and ≤ 1500 g and gestational age ≤ 32 weeks were randomly assigned to massage therapy by mothers plus skin-to-skin care (Intervention Group) or just skin-to-skin care (Control Group) during their hospital stay. Growth and neurodevelopment outcome were evaluated at 2 years corrected age.

Results

We followed 73 newborns (35 in Intervention Group, and 38 in Control Group). Both groups were similar in neonatal data. Growth at 2 years corrected age was similar in both groups. Intervention Group had borderline higher Psychomotor Development Index and significantly higher Mental Development Index scores than Control Group.

Conclusions

We suggest that massage therapy by mothers combined to skin-to-skin care during neonatal hospital stay improves neurodevelopment outcome at 2 years corrected age.     

First year growth among very low birth weight infants

Aim: The aim of this study was to describe first‐year growth among very low birth weight infants and the effect of growth restriction at hospital discharge on first year growth. Method: Anthropometric measures and background information for 118 very low birth weight infants were collected from medical records. Z‐scores were calculated based on recent Norwegian growth references. Results: Significant catch‐up growth for weight and length was observed during the first year with mean z‐score change (SD) of 0.40 (1.05) and 1.01 (1.25) respectively. However, the very low birth weight infants remained lighter and shorter than full‐term peers until 12 months corrected age with mean z‐score of ?0.93 (1.09) and ?0.48 (1.06) respectively. Head circumference followed a normal growth pattern after 2 months. Infants discharged from hospital as growth restricted had increased catch‐up in weight and length, but remained smaller than infants not subjected to early growth restriction and full‐term peers. Multiple regression showed that weight below the 10th percentile at discharge is important for weight and length during the first year of life. Conclusion: Very low birth weight infants showed catch‐up growth during the first year, but their weight and length remained less than full‐term peers. Growth deficiencies were more pronounced among infants subjected to early growth restriction, despite increased catch‐up growth.     

Children who were very low birth weight: development and academic achievement at nine years of age

Children born at very low birth weights (VLBW) (less than or equal to 1500 g) who were beneficiaries of modern neonatal intensive care are reaching middle childhood, and their school achievement can be evaluated. We compared 65 9-year-old children born in 1976, who were very low birth weight and who were free of neurological impairment, with 65 children of normal birth weight who had been matched for race, sex, age, and social class on measures of IQ, cognitive, visuo-motor, and fine motor abilities, and academic achievement. VLBW children scored significantly lower than controls on the WISC-R, Bender-Gestalt, Purdue Pegboard, subtests from the Woodcock Johnson Cognitive Abilities Battery, and reading and mathematics (math) achievement. Exploratory analysis of a subset of 43 VLBW and matched controls with IQ scores greater than or equal to 85 yielded a similar trend, except that, on achievement tests, differences were significant only in math. Further analyses revealed that the differential in math achievement between VLBW and control children is not fully attributable to differences in IQ.     

Cognitive performance at school age of very low birth weight infants with bronchopulmonary dysplasia

The hypothesis was that bronchopulmonary dysplasia (BPD) adversely affects cognitive performance at school age. This prospective cohort study examined three groups of children at 8 to 10 years of age. Group 1 (n = 311) consisted of very low birth weight (VLBW) infants without BPD and Group 2 (n = 95) consisted of VLBW infants with BPD. Group 3 (n = 188) consisted of term infants without BPD. Regression analysis determined the effect of BPD on eight performance measures while controlling for possible confounding variables. Children in Group 3 had the best performance and children in Group 2 had the poorest performance on all measures. These differences were significant (p = .0001) for the Full Scale IQ, Performance IQ, and reading and math grades and ages. Children in Groups 3 and 1 performed better than children in Group 2 for the Verbal IQ (p = .0001) and the Developmental Test of Visual-Motor Integration (p = .0012), but for these two measures there was no significant difference between children in Groups 3 and 1. Thus, poorer performance was found in VLBW infants with a history of BPD.