Sensorimotor skills associated with motor dysfunction in children born extremely preterm

Background

Children born prematurely, despite being free of intellectual and sensorineural deficits, are at risk of motor dysfunction.

Aim

To investigate the association of sensorimotor processing skills and Developmental Coordination Disorder (DCD) in “apparently normal” extreme preterm children.

Study design

In a matched case-control study, 50 preterm children born less than 29 weeks or birthweight < 1000 g, with an IQ > 85 and no identified sensorineural disability, were assessed at 8 years of age along with 50 gender and birth date matched classroom controls born at full term. A battery of sensorimotor tests was administered, which examined visual-motor, visual perception, tactile perception, kinaesthesia, and praxis.

Results

For preterm children with DCD (n = 21), significantly lower scores were found for the visual processing and praxis tests, with the exception of verbal command, in comparison to those 29 preterm children without DCD and term controls (median visual perception scores were 92, 96 and 108 respectively; design copying was 0.07, 0.46 and 0.95; constructive praxis was 0.09, 0.27 and 0.63; and sequencing praxis was 0.14, 0.73 and 0.96). There were no difference on the tactile sensitivity and kinaesthetic processing tests.

Conclusions

Preterm children with DCD have difficulty with visual processing tasks. Praxis or motor planning poses a particular challenge for them. Motor dysfunction in extremely preterm children was related to poorer visual processing and motor planning and may relate to a cognitive processing problem.     

Functional impairments at school age of preterm born children with late-onset sepsis

Background

Late-onset sepsis is a relatively common complication particularly of preterm birth that affects approximately a quarter of very low birth weight infants.

Aim

We aimed to determine the motor, cognitive, and behavioural outcome at school age of preterm children with late-onset sepsis compared to matched controls.

Study design and subjects

A prospective case-control study that included preterm infants (gestational age < 32 weeks and/or birth weight < 1500 g) admitted to our Neonatal Intensive Care Unit in 2000-2001 with a culture-proven late-onset sepsis, and controls matched for gestational age.

Outcome measures

At school age we assessed motor skills, intelligence, visual perception, visuomotor integration, verbal memory, attention, executive functioning, and behaviour.

Results

At 6-9 years, 21 of 32 children with late-onset sepsis (68%) had borderline or abnormal motor outcome with most problems in fine motor skills. Their total IQ was 89 compared to 98 in controls. In addition, verbal memory and attention were affected compared to controls (0.61 standard deviations (SD), 95% confidence interval (CI) 0.04-1.17, p = 0.033 and 0.94 SD, 95% CI 0.32-1.62, p = 0.011, respectively). Multiple episodes of sepsis and gram-negative sepsis were risk factors for worse cognitive outcome.

Conclusions

At school age, a majority of preterm children with late-onset sepsis had motor problems. Their IQ was considerably lower than matched controls, and memory and attention were specifically impaired. Outcome at school age of preterm children with late-onset sepsis was worse than previously thought.     

Declining cognitive development from 8 to 18 months in preterm children predicts persisting higher parenting stress

Background

Higher parenting stress in mothers of children born very preterm may be in part a response to poorer neurobehavioral development, reflecting realistic concerns in addition to adaptation to the trauma of preterm delivery. To our knowledge, there are few longitudinal studies of parenting stress that have addressed child cognitive competence.

Aims

To examine parenting stress in preterm and full-term children at 8 and 18 months corrected chronological age (CCA), in relation to child cognitive development and behavior.

Subjects

Participants were N = 152 children (98 preterm born ≤ 32 weeks gestation, and 54 full-term) seen at 8 and 18 months CCA, and the primary caregiver parent.

Study design/Outcome measures

The Parenting Stress Index questionnaire was completed by a parent, child interactive behavior was videotaped, and the Bayley Scales of Infant Development (BSID II, Mental Development Index; MDI) were administered at both ages.

Results

Total Parenting Stress was higher in preterm than full-term children at 8 and 18 months CCA (p < .02), accounted for primarily by the Child domain. Hierarchical regression showed (after controlling for neonatal risk, number of children in the home, child interactive behavior and maternal education) that decreasing Bayley MDI scores from 8 to 18 months CCA predicted higher parenting stress for preterm children. For full-term children, number of children in the home and child interactive behavior predicted parental stress at 18 months.

Conclusion

Higher parenting stress persisting to 18 months CCA in preterm children may partly reflect realistic parental concerns with their child's development.     

Family functioning, burden and parenting stress 2 years after very preterm birth

Background

Examining rates of difficulties in family functioning following very preterm birth has been a relatively neglected area of research.

Aims

To examine family functioning, burden and parenting stress in families with very preterm compared with term born children, and investigate influences of parental mental health problems and child neurodevelopmental disability on family outcomes in families with preterm children.

Study design

Participants were 184 very preterm and 71 term children and their parents. Parents completed the Family Assessment Device, Parenting Stress Index and Impact on Family questionnaires when their children were 2 years old (corrected for prematurity). Parental mental health and social risk information were also collected. Children were assessed for neurodevelopmental disability.

Results

Families with very preterm children reported poorer family functioning (p = .03) compared with families with term born children, with less evidence for differences between families with very preterm and term born children in parenting stress and family burden. Within very preterm families, parental mental health problems were associated with higher levels of parenting stress (p = .001), and parents of children with a neurodevelopmental disability were more likely to report higher family burden (p = .04).

Conclusions

For families with very preterm children, parental mental health symptoms and child neurodevelopmental disability may identify families at risk of greater stress and burden who may benefit from additional support.     

Behavior problems of 9-16 year old preterm children: biological, sociodemographic, and intellectual contributions

Background

Preterm children are at risk for behavior problems. Studies examining contributions of intellectual and environmental factors to behavior outcomes in preterm children are mixed.

Aims

(1) To identify the nature of maladaptive behaviors in preterm children age 9 to 16 years born across the spectrum of gestational age and birth weight (BW). (2) To examine contributions of BW as a biological factor, socioeconomic status as an environmental factor, and intelligence quotient (IQ) as indicative of intellectual ability to behavior outcomes.

Method

Using the Child Behavior Checklist, parent reports of behavior for 63 preterm children (gestational age 24 to < 36 weeks) were compared to 29 full term children of similar age, gender and socioeconomic status. Multiple regression models evaluated effects of prematurity, socioeconomic status, and intellectual ability on behavioral symptom scores.

Results

Preterm children had higher total and internalizing problem scores compared to full term children. They also had lower IQ. BW was a significant predictor of total and internalizing behavior problems. Among the syndrome scales, anxious/depressed and attention problems were elevated. Socioeconomic status did not contribute to behavior scores. IQ contributed to total, but not to internalizing or externalizing, scores. IQ contributed to attention problems, but not to anxious/depressed scores.

Conclusion

Preterm children had increased behavior problems, especially symptoms of inattention and anxiety. Lower BW predicted more behavior problems. IQ acted as a mediator between BW and attention scores, but not anxiety scores. These findings alert health care providers to assess anxiety in all preterm children regardless of intellectual ability and additional study on the influence of intellectual ability on behavioral outcomes in preterm children is needed.     

Predictive value of early motor evaluation in preterm very low birth weight and term small for gestational age children

Background

Motor problems are common in children born preterm or small for gestational age.

Aim

To study the predictive value of early motor assessments for later motor skills.

Subjects

Twenty-eight children born preterm with very low birth weight (VLBW: birth weight ≤ 1500 g), 57 children born small for gestational age (SGA: birth weight < 10th centile) at term and 77 term-born controls with normal birth weight.

Methods

The psychomotor development index (PDI) of the Bayley Scales of Infant Development was used as a measure of motor skills at age one, the Peabody Developmental Motor Scales (PDMS) at age five and the Movement Assessment Battery for Children (Movement ABC) at age 14. Low/borderline low scores were defined as < − 2SD/− 1SD (PDI) or < 5th/15th centile (PDMS; Movement ABC).

Results

In the VLBW group, motor problems in adolescence were identified both by low PDI (sensitivity: 0.80; 95%CI:0.38-0.96) and PDMS scores (sensitivity: 0.83; 95%CI:0.44-0.97). In the SGA and the control group sensitivity was poor for low PDI and moderate for low PDMS scores. However, in the SGA group, sensitivity increased when borderline low PDMS scores were used as cut-off (sensitivity: 0.75; 95%CI:0.41-0.93). Specificity of PDI and PDMS was high in all three groups.

Conclusions

Both PDI and PDMS may be valuable tools for early identification of motor problems in VLBW children, whereas PDMS best predicted motor problems in the two other groups. In all three groups, a normal motor examination at 1 and 5 years was highly predictive of normal motor skills at age 14.     

Brain positron emission tomography in preterm and term newborn infants

Objective

To study the clinical values of positron emission tomography (PET) in preterm and term newborn infants through observing brain glucose metabolism by ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) PET.

Method

To observe the brain ¹⁸F-FDG PET imaging in 9 term and 7 preterm newborn infants in the same condition after administration of 0.1 mCi/kg ¹⁸F-FDG.

Result

The brain ¹⁸F-FDG PET imaging showed that the uptake of ¹⁸F-FDG was relatively more in the thalamus, and less in the cerebral cortex in preterm and term newborn infants. The uptake of ¹⁸F-FDG of cerebral cortex in preterm infants was less than that in term infants, so the structure of brain ¹⁸F-FDG PET imaging was a little fainter in preterm neonates as compared with that in term newborns.

Conclusion

¹⁸F-FDG PET imaging could show different glucose metabolisms of brain in preterm and term infants. Brain ¹⁸F-FDG PET imaging might be a useful tool for estimating the brain function in newborn infants, and its clinical values need further investigation.     

Quality of general movements and psychiatric morbidity at 9 to 12 years

Background

General movements (GMs) form the basic motility of young infants. The quality of GMs may predict neurological outcome, but little is known about relationships between GM-quality and behavioral problems, including those resulting in overt psychiatric morbidity.

Aim

To explore relationships between abnormal GMs and behavioral problems, in particular relationships between abnormal GMs and Attention Deficit Hyperactivity Disorder (ADHD) with or without psychiatric co-morbidity at school-age.

Methods

Twenty-five low-risk full term infants and 16 infants at high risk for neurodevelopmental disorder but without cerebral palsy were studied prospectively. GM-quality was assessed during ‘writhing’ age (around term till 2 months post-term) and ‘fidgety’ age (2-4 months post-term). GMs were classified into normal and abnormal movements. When the children were 9-12 years, parents completed the Child Behavior Checklist (CBCL) and provided information on the presence of psychiatric diagnoses; teachers completed the Teachers Report Form (TRF). Both parents and teachers completed a questionnaire on ADHD-like behavior.

Results

Abnormal GMs at ‘writhing’ and ‘fidgety’ age were related to the presence of ADHD with psychiatric co-morbidity (p < 0.05), but not to isolated ADHD. Abnormal GMs at ‘fidgety’ age were weakly related to problematic behavior at school (TRF-scores) and hyperactive behavior at home (ADHD-questionnaire).

Conclusions

This explorative study suggests that abnormal GMs in early infancy may be associated with an increased risk for behavioral problems, in particular for ADHD with psychiatric co-morbidity at school-age.     

Early school-based learning difficulties in children born very preterm

Background

Educational underachievement is a major morbidity associated with very preterm (VPT) birth. However, few studies have examined early school outcomes with most employing global, clinic based measures.

Objective

To examine the early school achievement in a cohort of children born VPT and studied to age 6 years.

Methods

A regional cohort of 102 VPT children (≤ 33 weeks GA) were followed prospectively alongside a comparison group of 108 full term (FT) children born during the same period (1998-2000). At 6 years corrected age, all children underwent a comprehensive neurodevelopmental evaluation that included the Woodcock-Johnson Tests of Achievement (WJ-III), teacher report and national numeracy and literacy test results. Rates of specific learning disabilities (LD) were also examined.

Results

VPT children performed less well than FT children on WJ-III subtests (ps < .05), national tests (ps < .01), and in all curricular areas rated by teachers (ps < .01) except expressive language. Even VPT children without severe neurodevelopmental impairment scored lower on the WJ-III math, national tests (ps < .05) and were 2-3 times more likely to show delays (ps < .02) in math (43% vs. 19%), written language (36% vs. 22%), language comprehension (26% vs. 14%), handwriting (36% vs. 17%), spelling (38% vs. 30%) and physical education (33% vs. 11%). They were also twice as likely as FT children to have math LD (47% vs. 21%).

Conclusions

By age 6, a substantial proportion of VPT children are lagging behind their FT peers across multiple curriculum areas, with difficulties being most prominent in math. Findings highlight the need for early identification and educational supports to help maximise VPT children's learning opportunities during the transition to school.     

Measuring preterm cumulative stressors within the NICU: The neonatal infant stressor scale

Background

Stress experiences, while pervasive, are less likely than painful experiences to be managed in still-hospitalised preterm infants.

Aim

We aimed to quantify the severity of common stressors for preterm infants with a view to providing a tool to manage presumed accumulated infant stress.

Methods and subjects

Seventeen doctors and 130 nurses who work in Neonatal Intensive and Special Care Nurseries rated the perceived stress severity of 44 acute events and 24 chronic living conditions for preterm infants at three ages (< 28 weeks, 28-32 weeks, > 32 weeks post-conceptional age) and for themselves. Acute items (such as heel lance) were organised into nursing, peripheral venous access, peripheral arterial access, central vascular access, ventilation, nutrition, medical procedures, surgery, radiology and miscellaneous categories. Chronic living conditions included items such as receiving intranasal oxygen and having a systemic infection.

Results

Doctors and nurses perceived nearly all items to be stressful to infants to some degree and to be equally stressful across ages. The degree of stress experienced by clinicians themselves was generally low and moderately correlated with presumed infant stress for the same items. Presumed infant stress was inversely related to clinician age.

Conclusion

Based on these results we developed the Neonatal Infant Stressor Scale to help track, measure and manage presumed accumulated stress in preterm neonates.     

A prospective study of maternal anxiety, perceived stress, and depressive symptoms in relation to infant cognitive development

Aim

Our objective was to examine the associations between maternal psychological health (trait anxiety, perceived stress, and depressive symptoms) during pregnancy or postpartum and infant visual, language, motor, and overall cognitive development.

Study Design and Methods

In the prospective Pregnancy, Infection, and Nutrition Study (2001-2006), central North Carolina women completed self-administered questionnaires during pregnancy to assess trait anxiety and depressive symptoms. An in-person interview assessed maternal perceived stress and depressive symptoms in the 4th postpartum month. Infant development was assessed at 12 months using the Mullen Scales of Early Learning (n = 358). Multiple linear regression with restricted cubic splines was used to examine potential non-linear associations between trait anxiety, perceived stress, and depressive symptoms in relation to Mullen sub-scales and Composite scores.

Results

Increasing maternal anxiety was associated with poorer overall cognition (adjusted β for Composite = − 0.2, 95% CI: −0.4, 0.0). Postpartum stress was positively associated with language development and general cognition (adjusted β for Expressive Language = 0.2, 95% CI: 0.0, 0.4; adjusted β for Composite = 0.3, 95% CI: 0.0, 0.6). Elevated depressive symptoms throughout pregnancy and postpartum were associated with better fine motor skills (adjusted β = 9.7, 95% CI: 3.9, 15.5). Anxiety, postpartum depressive symptoms and stress were associated with gross motor skills in a non-linear fashion, as were postpartum depressive symptoms and stress with expressive language.

Conclusions

Maternal trait anxiety, depressive symptoms and stress had little negative influence on infant cognitive development. In fact, moderate psychosocial distress may slightly accelerate motor development in particular, and some aspects of language.     

A comparison of executive function in very preterm and term infants at 8 months corrected age

Background

Executive function (EF) emerges in infancy and continues to develop throughout childhood. Executive dysfunction is believed to contribute to learning and attention problems in children at school age. Children born very preterm are more prone to these problems than their full-term peers.

Aim

To compare EF in very preterm and full-term infants at 8 months after expected date of delivery.

Subjects

37 very preterm infants without identified disabilities, and 74 gender and age matched healthy full-term infants. The very preterm infants were all ≤ 32 weeks gestation and < 1250 g birthweight.

Outcome measures

EF tasks which measured working memory, inhibition of distraction, and planning at 8 months after expected date of delivery.

Results

The very preterm infants performed significantly more poorly than the full-term infants on all measures of executive function. No significant differences were found between very preterm and full-term infants on any of potentially confounding variables of, infant temperament, maternal education, family income and maternal psychological wellbeing. Very preterm infants had significantly lower scores on the Mental Development Index (MDI) and Psychomotor Development Index (PDI) on the Bayley Scales of Infant Development (BSID II), however when this was partialled out the differences in EF scores remained. Medical complications, lower birthweight and lower gestation age were all found to adversely affect the performance of very preterm infants on executive function tasks.

Conclusion

Very preterm infants performed more poorly than full-term infants on measures of EF. Further follow up studies are required to investigate whether EF measures in infancy can predict learning and attention outcome at school age.     

The effects of multiple pre- and perinatal risk factors on the occurrence of cerebral palsy. A Norwegian register based study

Aims

To examine the effects of multiple risk factors on cerebral palsy (CP).

Materials/methods

For 176,591 Norwegian infants born 1996-98 and surviving the early neonatal period, data on a number of potential pre- and perinatal risk factors (RFs) for CP were available in the Medical Birth Registry of Norway. For 241 children with CP detailed clinical data were available in the Norwegian CP registry.

Results

In children born at term, 31% had no RF, and none had five or more, while in children born preterm, 9% had no RF in addition to prematurity (p < 0.001 vs. term), and 5% had five or more (p < 0.02 vs. term). In both groups, few children shared the same combination of RFs. Interdependent sequences were more often observed among children born preterm than at term (p < 0.001 vs. term). The most detrimental effect was observed for the combination of maternal disease and low 5-min Apgar score, registered in 11.2% of children with CP. The combination of maternal disease and premature birth had an interaction contrast ratio of 9.25 (CI: 3.56; 14.94), which may be consistent with biological interaction.

Conclusions

The majority of children with CP born at term most likely had an antenatal or single cause, suggesting individual susceptibility to an injury. The majority of children born preterm, had combinations or sequences of antenatal and perinatal risk factors as the most likely cause of CP.     

Visual, motor and perceptual abilities at school age in children with isolated mild antenatal ventricular dilatation

Background

The detection of prenatal ventriculomegaly raises anxiety about possible neurological sequelae. A few studies have investigated possible neurodevelopmental sequelae in the first years after birth but no systematic assessment has been performed at school age.

Aims

The aim of this study was to assess minor neurological signs, perceptual and visual function in a cohort of children with isolated mild antenatal ventricular dilatation examined at school age.

Study design

Seventeen children with evidence of mild antenatal ventriculomegaly in the second and third trimester of pregnancy were included in the study.

Outcome measures

Children were assessed at school age (range 5 years 3 months-11 years, 11 months) using a structured neurological examination for minor neurological signs and age specific tests assessing perceptual motor abilities (Developmental Test of Visual-Motor Integration; Movement Assessment Battery for Children).

Results

Only one of the 17 children had abnormal results. The remaining 16 had normal results on all the tests, irrespective of the magnitude and the symmetry of the dilatation or of its evolution on neonatal scan.

Conclusions

Our results suggest that children who had mild isolated prenatal ventricular dilatation are unlikely to develop even minor motor or perceptual difficulties at school age.     

Parents' Perceptions of Their Children's Weight, Eating Habits, and Physical Activities at Home and at School

Introduction

Parental perceptions of their young children's weight and habits may play an important role in determining whether children develop and maintain healthy lifestyles. This study was conducted to determine perceptions of parents of third-grade children in an urban school setting regarding their children's weight, eating habits, and physical activities.

Methods

Parents anonymously completed surveys about their child's weight, eating habits, and daily activities. The survey also asked about how schools could encourage healthy eating and increased physical activity.

Results

Overall, 26% of the parents perceived their child to be overweight and expressed concern, but 40% of these parents believed that overweight is a condition that will be outgrown. Parents who reported eating more than eight meals per week with their child were less likely to report their child as overweight and more likely to believe that their child's physical activity level was appropriate.

Discussion

Most parents of third-grade students demonstrated concern regarding their child's weight and perceive obesity as a problem. Parents support school interventions such as nutrition education and fitness classes.     

Prognostic value of a scorable neurological examination from 3 to 12 months post-term age in very preterm infants: A longitudinal study

Aims and study design

The Hammersmith Infant Neurological Examination proved effective in predicting locomotor function in very preterm infants after 9 months of age. We performed the examination in a cohort of 103 very preterm infants (gestational age below 32 weeks) as early as 3 months' post-term age, and longitudinally at 6, 9 and 12 months. Our aim was to establish the frequency distribution of the optimality scores at each age period, to explore the predictive value of the examination from 3 months onwards as to developmental outcome and locomotor function at 2 years, and to explore its longitudinal consistency.

Results

The results showed that this standardized neurological examination can be performed in preterm infants as early as 3 months' post-term age to predict motor outcome at 2 years, and that its high predictive value is consistent across the first year of life due to an effective combination of different items for each age period.

Conclusions

We confirm the high predictive value of this neurological examination in very preterm infants after 9 months and extend it to the assessments performed as early as 3 months post-term. This is of great relevance as in very preterm infants early prediction of motor function is essential for a prompt planning of therapeutic interventions.     

A model to predict motor performance in preterm infants at 5 years

Background

Approximately 60% of preterm infants who are assessed at 5 years for motor performance in a standardized multidisciplinary follow-up program are found to have normal results, indicating that, for these children, routine motor assessment at this age is unnecessary.

Aim

To improve the efficiency of our follow-up practice for motor assessment by developing a model to predict motor performance of preterm infants at 5 years with a maximal sensitivity (≥90%).

Study design

Longitudinal design.

Subjects

We included preterm infants (n = 371) with a gestational age of ≤32 weeks; children with severe disabilities were excluded.

Outcome measures

The Movement Assessment Battery for Children (M-ABC) at 5 years with ‘delayed’ motor performance (<15 percentile) was the dependent variable. As factors in the model, we used twenty neonatal risk factors, the maternal education level, the Motor Scale and the Behavior Rating Scale (BRS) of the Bayley Scales of Infant Development, 2nd edition, at 2½ years.

Results

Binary logistic regression analysis revealed that the prediction model (n = 345) reached a sensitivity of 94%. Five factors contributed significantly (p < 0.05) to the model: a Motor Scale PDI <90 and a BRS ‘motor quality’ <26 percentile, and the neonatal risk factors gestational age <30 weeks, male gender and intra-ventricular hemorrhage.

Conclusion

The prediction model can improve the efficiency of follow-up practice for motor assessment by 37% at 5 years. Applying this model, we would not have assessed 129 children and would have missed six children.     

Motor trajectories from 4 to 18 months corrected age in infants born at less than 30 weeks of gestation

Background

Preterm infants are recognised as developing at a significantly slower rate than their full-term peers and with different movement quality.

Aim

This study aimed to describe the longitudinal gross motor trajectories of these infants in the first 18 months of (corrected) age and investigate factors associated with gross motor development.

Study design

A longitudinal study was conducted with convenience samples of 58 preterm infants born ≤ 29 weeks of gestation and 52 control full-term infants in Australia.

Outcome measures

The infants were assessed at 4, 8, 12 and 18 months of (corrected) age using the Alberta Infant Motor Scale (AIMS).

Results

Forty-six preterm and 48 control infants completed all four assessments. The preterm group scored significantly lower on various sub-scores at all age levels. Almost half of the preterm infants demonstrated less progression in the sit sub-scale from 4 to 8 months (corrected) age, possibly due to an imbalance between flexor and extensor strength in the trunk. At 12 and 18 months of (corrected) age, lack of rotation and fluency in their movements were evident in some preterm infants. Presence of intra-ventricular haemorrhage and chronic lung disease were associated with poor motor performance at 4 months and use of postnatal steroids was associated with poor motor performance at 4, 8 and 18 months of corrected age.

Conclusion

The imbalance between flexor and extensor muscle strength in preterm infants had a stronger impact on motor development than usually expected. The AIMS appears to be a sensitive assessment tool to demonstrate the unique movement characteristics in this preterm cohort.     

Circulating adipocyte fatty acid binding protein levels in healthy preterm infants: Positive correlation with weight gain and total-cholesterol levels

Background

Adipocyte fatty acid binding protein (a-FABP) has been suggested to play an important role in the pathogenesis of metabolic syndrome. Preterm infants are at risk for the later development of insulin resistance, and, possibly, other components of metabolic syndrome.

Aim

To determine circulating levels of a-FABP in preterm infants and examine possible associations of a-FABP with metabolic indices (serum lipids, glucose, and insulin levels, and homeostasis model assessment index of insulin resistance [HOMA-IR]), levels of leptin and adiponectin, anthropometric parameters and weight gain.

Study design

Prospective cohort study.

Subjects

55 healthy preterm (mean [SD] gestational age 32.8 [1.8] weeks) and 23 fullterm infants (reference group).

Outcome measures

Serum a-FABP, lipids, glucose, insulin, leptin and adiponectin levels at 31.9 [10.4] days of life.

Results

Serum a-FABP levels did not differ significantly between preterm and fullterm infants. A-FABP levels correlated positively with total-cholesterol [total-C] in both preterm and fullterm infants (β = 0.33; p = 0.01 and β = 0.33; p = 0.04, respectively). In addition to total-C, weight gain correlated independently with a-FABP levels in preterm infants (β = 0.36, p = 0.01).

Conclusions

An association between a-FABP levels and indices of insulin resistance was not present in infants studied. As the development of insulin resistance in children born prematurely is possibly associated with weight gain in early postnatal life, follow-up of our study population is necessary to demonstrate whether a-FABP levels, shown to correlate with weight gain in preterm infants, are a predictive marker for the later development of insulin resistance in these infants.     

Oxidative burst and phagocytosis of neonatal neutrophils confronting Candida albicans and Candida parapsilosis

Background

Candida albicans and Candida parapsilosis are important causes of sepsis among premature neonates. The neutrophil is a key element in the control of Candida infections, yet specific neutrophil mechanisms that may contribute to the susceptibility of the premature neonate to candidiasis are not well understood.

Aims

The hypothesis for this study is that neonatal neutrophils have a developmental deficiency in their capacity to generate an oxidative burst in response to Candida species.

Study design

Neutrophils were isolated from cord blood of term and preterm infants and from peripheral blood of adult volunteers. Neutrophils were exposed to Candida species, and assays of oxidative burst and phagocytosis were conducted.

Results

Oxidative burst of neutrophils from term and preterm (22-29 weeks) neonates exposed to C. albicans hyphae was similar to adult neutrophils. No detectable burst was induced in either group by exposure to C. parapsilosis yeast, and was attenuated by exposure to C. albicans yeast. Because no deficiency in oxidative burst was seen, phagocytosis was also studied. Phagocytosis of unopsonized C. albicans yeast was low in both adult and neonatal neutrophils (10-12%), but was more efficient with C. parapsilosis as target (76-88%). Neutrophils from both term and preterm infants were capable of phagocytosis equivalent to adults.

Conclusion

A deficiency in generation of an oxidative burst or phagocytosis may not contribute to the increased susceptibility of preterm neonates to infections with Candida.