Patterns of cognitive functioning in school-aged children with Noonan syndrome associated with variability in phenotypic expression

OBJECTIVE: To evaluate the cognitive profiles of children with Noonan syndrome (NS) and to relate these profiles to measures of overall clinical severity. STUDY DESIGN: Thirty-five children with NS between the ages of 7 and 18 years were tested on their intellectual, psychosocial, and academic functioning. The diagnosis of NS was established on the presence of a typical face, the characteristic heart defect, thorax deformity, short stature, affected first-degree relative(s), and cryptorchidism in male subjects. RESULTS: The total group of children with NS (n = 35) achieved significantly lower mean full-scale IQ, verbal IQ (VIQ), and performance IQ (PIQ) scores (between 85.9 and 89.3) than expected based on normative data. The individual full-scale IQ scores varied between 48 and 130. Because of this wide range of individual scores, the mean group values are not extremely informative. The mean full-scale IQ for the group with moderate NS (n = 19) is 90.8; for the children with severe NS (n = 16) the mean full-scale IQ is 80.6. The patterns of discrepancies between VIQ and PIQ are: (1) an extreme discrepancy between VIQ and PIQ is most likely to emerge in children with severe NS with (low) average intellectual abilities; (2) children with moderate NS are more likely to attain similarities in VIQ and PIQ scores; and (3) children with moderate NS demonstrate a particular pattern of discrepancy between VIQ and PIQ (ie, VIQ > PIQ). CONCLUSION: For children with NS, the findings on physical examination are indicative of the pattern of cognitive abilities. NS is not associated with substantial deficits in the level of intellectual functioning or with a single/unitary cognitive pattern. Severe NS expression, however, predicts in part a specific pattern of deficits and capacities in cognitive functioning.     

Vulnerability for psychopathology in Klinefelter syndrome: age-specific and cognitive-specific risk profiles

Aim: Studying Klinefelter syndrome (KS) (47,XXY) can reveal insights into mechanisms of neurodevelopment. Our aim was to identify factors that influence risk for psychopathology in this syndrome, with a focus on age‐specific and cognitive‐specific risk profiles. Methods: A total of 73 subjects with KS (25 children and 48 adults) and 93 age‐matched controls (53 children and 40 adults) participated in the study. The discrepancy between verbal IQ (VIQ) and performance IQ (PIQ) was assessed using the Wechsler Intelligence Scales. IQ data were only measured in the Klinefelter group. All participants completed the Autism Questionnaire and Schizotypal Personality Questionnaire. Results: Increased levels of autism traits and schizotypal traits were observed in individuals with KS, with schizotypal traits increasing with age. The VIQ < PIQ group (n = 33) showed significantly increased levels of autism traits compared to the PIQ < VIQ group (n = 12) and controls. The PIQ < VIQ group showed significantly increased levels of schizotypal traits compared to the VIQ < PIQ group and controls. The VIQ–PIQ discrepancy significantly correlated with schizotypal traits and autism traits, in opposite directions. Conclusion: Risk for psychopathology in KS may be age specific as well as dependent on cognitive profile. Relative deficits in verbal abilities seem more strongly associated with increased autism traits, whereas relative deficits in visuospatial abilities seem more strongly associated with increased schizotypal traits.     

Long-term neurodevelopmental outcome of preterm children with unilateral cerebral lesions diagnosed by neonatal ultrasound

OBJECTIVE: Little information is available on long-term neurodevelopmental outcome of preterm infants with unilateral cerebral lesions detected by neonatal cranial ultrasound. This study aims to investigate the long-term outcome in a cohort of very preterm infants with unilateral cerebral lesions acquired in the perinatal period. METHODS: A prospective cohort study of 668 preterm infants (<33 weeks gestation; birth years 1985-1991) at a single tertiary perinatal centre in the UK. All infants had serial cranial ultrasound examination in the neonatal period. Outcome was assessed at age 8 years with the Wechsler Intelligence Scales for Children (WISC-R), Test of Visuo-motor Integration (VMI) and the Test of Motor Impairment (TOMI). RESULTS: Of the 668 infants, 369 infants had normal ultrasound scans. Two hundred and ninety nine children had bilateral parenchymal or non-parenchymal lesions (57 left-sided, 41 right-sided, 201 bilateral). Five hundred and thirty four (79%) children attended follow-up at age 8 years. Mean Full Scale IQ (FSIQ) was 101 (SD+/-16), 93 (SD+/-17), 102 (SD+/-17) and 91 (SD+/-21) for normal, left-sided, right-sided and bilateral lesion groups respectively. In all groups verbal IQ (VIQ) was higher than performance IQ (PIQ). Scores of FSIQ, VIQ and PIQ, VMI and TOMI were significantly different between the groups. After exclusion of children with parenchymal lesions, however, the difference was only significant for the TOMI scores. In all tests, children with left-sided lesions performed poorer than children with right-sided lesions. CONCLUSIONS: In this cohort of preterm infants with unilateral cerebral lesions, verbal function was preserved over non-verbal function independently of the side of lesion. Furthermore, the results suggest that the neurodevelopmental outcome of children with left-sided lesions is less favourable than that of children with right-sided lesions.     

The correlation of deficits in IQ with midface and digit hypoplasia in children exposed in utero to anticonvulsant drugs

OBJECTIVE: Children exposed during pregnancy to the anticonvulsant drugs phenytoin, phenobarbital, and carbamazepine as monotherapy and polytherapy have an increased frequency of midface and digit hypoplasia. Some children also have cognitive dysfunction. The hypothesis tested is that the anticonvulsant drug-exposed child with midface and digit hypoplasia is more likely to have cognitive dysfunction. METHODS: Children exposed to anticonvulsant drugs (n = 80) were recruited for a follow-up evaluation, which included testing cognitive function and a physical examination for head size, height, and the presence of midface and digit hypoplasia. Microcephaly, midface and digit hypoplasia, and major malformations were correlated with full scale (FSI), performance (PIQ) and verbal (VIQ) intelligence. RESULTS: The presence of the 3 anticonvulsant-exposed children with microcephaly had a deficit of 23.7 IQ points in FSI in comparison with the other children with a normal head size. Either midface or digit hypoplasia, after excluding the persons with microcephaly and with the Bonferroni correction, correlated significantly with deficits in VIQ (-12.7), PIQ (-10) and FSI (-12.8) IQ points ( P = .0061). There was no decrease in IQ in association with major malformations. CONCLUSION: The presence of midface and digit hypoplasia in a child exposed to anticonvulsant drugs in pregnancy is an indication for a systematic developmental evaluation.     

Learning disabilities in a population-based group of children with hydrocephalus

AIM: To assess cognitive functions in a population-based group of children with hydrocephalus and to analyse differences between children with and without myelomeningocoele (MMC); with hydrocephalus already present at birth and those who developed it later; children born at full term and those born preterm. METHODS: Of 103 children with hydrocephalus born in the western-Swedish region in 1989-1993, 73 were assessed using the Wechsler Intelligence Scales or the Griffith Developmental Scales. RESULTS: One-third of the children were normally gifted (IQ >85), another 30% had a low average IQ of 70-84 and 37% had learning disabilities with an IQ of <70. The median IQ was 75, verbal IQ 90 and performance IQ 76 (p<0.001). An IQ of <70 was found in 19 of 45 (42%) children without MMC and in 8 of 28 (29%) of those with MMC. Children born preterm had a lower IQ of 68 than those born at full term with an IQ of 76, while children with hydrocephalus present at birth but without MMC had a lower IQ of 60 than the others with an IQ of 77. Children with cerebral palsy and/or epilepsy (n=22) had a lower IQ of 66 than the IQ of 78 in those without these impairments (p<0.01). CONCLUSION: Cognitive functions in children with hydrocephalus need to be carefully assessed before school age to ensure adequate support and education. Even the one-third near normally gifted children with an IQ of 70-85 require special attention, due to the profile of relatively well-preserved verbal functions but greatly impaired perceptual and non-verbal abilities.     

Duchenne肌营养不良患儿的智力特点及与基因突变关系初步探讨

目的：了解国内Duchenne肌营养不良（DMD）患儿智力水平及智力低下的比例,初步探讨DMD患儿智力的结构特点及与基因突变类型的关系。方法：选择2009年1月至2011年3月的102例DMD患儿,其中84例患儿通过多重连接依赖式探针扩增（MLPA）方法进行DMD基因检测。102例DMD患儿中,选择≥6岁的50例DMD患儿作为DMD组;另选取50例年龄、性别与DMD组匹配的健康体检儿童作为对照组。采用韦氏智力量表对两组儿童进行智力及智力结构分析。结果：102例DMD患儿的平均智商为84±21,其中30例（29.4%）总智商低于70。DMD组患儿总智商、言语智商、操作智商及其11项分测验得分均显著低于对照组（P<0.01）。其中DMD基因56-79号外显子突变患儿的智商最低(59.3±11.9),另外,45-55号外显子突变患儿的智商(88.6±1.9) 明显低于1-29号(97.5±9.6)和30-44号(102.8±3.8)外显子突变的患儿（P<0.01）。结论：DMD患儿的总智商、言语智商、操作智商均显著低于正常儿童。DMD患儿智力低下与基因突变存在联系。     

长沙市学龄儿童睡眠不足对智力结构的影响

目的：探讨小学生睡眠不足对智力发育的影响,为有效干预提供科学理论依据。方法：2009 年 6 月至 2010 年 4 月,在长沙市4 个行政区分层随机抽取4所小学10~11岁5年级小学生316名进行调研,了解其不同程度的睡眠不足在中国韦氏儿童智力量表测验上反映的智力结构特点。结果：收回有效问卷286份,应答率90.5%,其中睡眠时间正常（夜间睡眠时间≥8 h,对照组）106人,睡眠不足180人（夜间睡眠时间<8 h,睡眠不足组）。睡眠不足组各项分测验、言语智商、操作智商和总智商得分均显著低于对照组（P<0.05）,语言理解因子和记忆/注意因子得分亦显著低于对照组（P<0.05）。与对照组比较,中度睡眠不足亚组语言智商、总智商及语言理解因子、记忆/注意因子得分降低（P<0.05）;重度睡眠不足亚组各项得分均降低（P<0.05）。睡眠不足组及中度和重度睡眠不足亚组儿童中智力不平衡者的比例显著高于对照组（P<0.05）。结论：睡眠不足对小学生智力发育有不良影响,尤其是对言语智商发育的影响较大,主要发生于中、重度睡眠不足的小学生。     

Hemoglobin status associated with performance IQ but not verbal IQ in Chinese preschool children

Background: Despite the body of literature that links anemia with poorer cognition in children and the evidence that the severity of the effects of anemia on children's cognition vary in different populations, few studies have investigated the effects of anemia on the cognitive development of Chinese children. Methods: This longitudinal cohort included 171 children from a developing region of China. Hemoglobin (Hb) and iron levels were taken when the children were 4 years old. At age 6, the children's cognition was tested with the Chinese Wechsler Preschool and Primary Scale of Intelligence. Psychosocial information was also used in analyses. Results: Results showed that the children who had low Hb levels had significantly lower scores in performance IQ (PIQ), but not verbal IQ. Although blood Fe levels were not shown to moderate the link between Hb levels and IQ, we found children who performed the best on IQ tests exhibited low iron levels concurrent with high Hb levels, whereas the group who performed the worst exhibited high iron but low Hb levels. We also found that psychosocial adversity did not differ significantly between children who had normal or low Hb levels, although the effect of Hb on PIQ became only suggestive after controlling for psychosocial adversity, therefore the correlation is not causal but only a suggestive association. Conclusion: Our findings are in agreement with literature on the negative effects of anemia on children's cognition and point to the possibility that the portions of the brain associated with PIQ components are particularly affected by low Hb during crucial periods of development.     

中国大陆学习困难儿童韦氏智力测验对照研究的Meta分析

目的 评估中国学习困难和正常儿童韦氏儿童智力量表(WISC)测量的差异。方法 检索PubMed、MD Consult、中图公司免费外文期刊整合库（cnpLINKer）、中国知网和万方生物医学期刊数据库,检索时间均从建库至2012年5月。获得中国学习困难和正常儿童WISC测量的对照研究,WISC中文版本为北京师范大学版（WISC-CR）或湖南医科大学版（C-WISC）。提取总智商（FIQ）、言语智商（VIQ）和操作智商（PIQ）。应用RevMan 5.0软件进行Meta分析,根据异质性结果选择相应的效应模型分析,并进行亚组分析。结果 23篇文献进入Meta分析,研究实施地均为中国大陆;10篇文献采用WISC-CR,13篇文献采用C-WISC;12篇文献研究现场为医院门诊或儿童保健门诊,对照组基本为来院智力检测的正常儿童;13篇文献研究现场为学校,对照组来自同校或同班同学。①FIQ、VIQ和PIQ异质性检验提示具显著异质性,均采用随机效应模型分析。Meta分析结果显示,FIQ、VIQ和PIQ的WMD分别为-16.23（95％CI:-18.20~-14.25）、-18.90(95%CI:-21.04~-16.77)和-11.92(95%CI:-13.90~-9.94);学习困难组均显著低于对照组（P均<0.000 01）。②对纳入文献的依据诊断方法、研究现场、WISC版本行异质性原因分析,结果显示不能消除异质性。③对VIQ和PIQ各分项进行亚组分析,结果显示VIQ的6个分项（常识、类同、算数、词汇、理解、数字广度）和PIQ的5个分项（填图、排列、积木、拼图、译码）的文献间均具显著异质性,采用随机效应模型分析。Meta分析结果显示,学习困难组VIQ和PIQ各分项得分均显著低于对照组（P均<0.001）。结论 中国大陆学习困难儿童FIQ、VIQ和PIQ低于正常儿童,VIQ的延迟发展更明显。VIQ和PIQ各分项中以常识、类同、积木和译码的延迟发展更明显。     

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目的分析原发性遗尿症(PNE)患儿智力结构,探讨单纯PNE患儿灰质形态学改变状况。方法 2006年10月至2011年8月解放军第463医院儿科就诊的75例右利手PNE患儿(PNE组)及72名正常儿童(对照组),采用中国韦氏儿童智力量表(C-WISC)进行智力测试,计算言语智商(VIQ)、操作智商(PIQ)、总智商(FIQ)、记忆或不分心(M/C)因子等指标;而后进行高分辨率T1WI磁共振成像(MRI)扫描,采用VBM5工具包,对所有被试T1WI图像进行基于体素的形态学分析(VBM),采用t检验进行组间分析,比较单纯PNE患儿脑区激活状况与正常对照组相应脑区灰质密度(GMD)。结果 PNE组FIQ、VIQ和PIQ均正常,与对照组差异无统计学意义(P>0.05)。PNE组M/C因子低于对照组[(100.80±16.83)与(92.73±18.46)],差异有统计学意义(P<0.01);VBM分析表明,PNE患儿小脑左后部及右侧背侧前额叶(dLPFC)灰质密度程度明显低于对照组,差异有统计学意义(P<0.001)。结论 PNE患儿智力结构不平衡,存在注意功能缺陷。左侧小脑及右侧dLPFC功能障碍与其注意功能缺陷有关。     

遗尿症患儿智力水平和智力结构分析

目的：有文献报道原发性夜间遗尿症 (PNE) 患儿存在注意力/记忆力缺陷,并认为这种缺陷可能与患儿的智力情况有关,因此该研究对PNE患儿的智力水平和智力结构进行分析。方法：采用中国韦氏儿童智力量表（C-WISC）对40例PNE患儿的智力结构进行测试,并与40例年龄和性别相匹配的正常儿童进行对照研究。结果：PNE组的总智商（FIQ）、言语智商（VIQ）和操作智商（PIQ）均在正常范围,与对照组比较差异无显著性（P＞0.05）,但数字广度、编码、知识与算术分测验量表分与对照组比较差异有显著性 (P＜0.05);记忆/不分心因子（M/C）与对照组比较差异有显著性 (P＜0.05);两组PIQ与VIQ差值比较,差异无显著性（P＞0.05）。结论：PNE患儿智力水平正常,但智力结构中的记忆/不分心因子存在一定缺陷,提示可能与大脑额叶执行功能异常有关。［中国当代儿科杂志,2007,9（5）：433-435］     

胎儿生长受限儿童学龄期的智力水平和智力结构分析

目的：探讨胎儿生长受限（FGR）儿童学龄期的智力水平和智力结构状况。方法：采用韦氏儿童智力量表对54名FGR的学龄期儿童和84名出生体重正常儿童进行智商测定,并对其智力结构进行分析。结果：FGR组的总智商（FIQ）、言语智商（VIQ）、操作智商（PIQ）分别为105.9±10.3、112.4±11.2、97.1±10.6,且均在正常范围,但PIQ显著低于对照组（104.8±10.5; P<0.001）;操作分量表中的图片排列和编码的分测验分数亦显著低于对照组（P<0.01）,儿童智力三维因子中的知觉组织因子和记忆/注意因子分别为99.8±11.1和116.3±14.4,均落后于对照组（分别为104.6±11.5和113.4±14.5;P<0.05）。结论：FGR儿童的总体智力水平正常,但智力结构不平衡,可能存在与操作能力相关的大脑右半球功能障碍,因此对这部分儿童应在幼儿期及早进行操作能力方面的训练。［中国当代儿科杂志,2009,11（10）：833-835］     

The effect of early human diet on caudate volumes and IQ

Early nutrition in animals affects both behavior and brain structure. In humans, randomized trials show that early nutrition affects later cognition, notably in males. We hypothesized that early nutrition also influences brain structure, measurable using magnetic resonance imaging. Prior research suggested that the caudate nucleus may be especially vulnerable to early environment and that its size relates to IQ. To test the hypothesis that the caudate nucleus could be a neural substrate for cognitive effects of early nutrition, we compared two groups of adolescents, assigned a Standard- or High-nutrient diet in the postnatal weeks after preterm birth. Groups had similar birth status and neonatal course. Scans and IQ data were obtained from 76 adolescents and volumes of several subcortical structures were calculated. The High-nutrient group had significantly larger caudate volumes and higher Verbal IQ (VIQ). Caudate volumes correlated significantly with VIQ in the Standard-nutrient group only. Caudate volume was influenced by early nutrition and related selectively to VIQ in males, but not in females. Our findings may partly explain the effects of early diet on cognition and the predominant effects in males. They are among the first to show that human brain structure can be influenced by early nutrition.     

拉莫三嗪、丙戊酸钠对癫(癎)儿童认知功能的影响

目的：探讨拉莫三嗪（LTG）和丙戊酸钠（VPA）对癫痫儿童认知功能的影响。方法：首次确诊的癫痫患儿76例中，36例用LTG单药治疗，40例用VAP单药治疗。用药6个月前后对二组进行智力（IQ）测定。同时选取20例健康儿童作为健康对照组。结果：1．癫痫患儿语言智商（VIQ）、操作智商（PIQ）和总智商（FIQ）明显低于健康对照组，各项分测验得分亦均降低（Pa〈0．05）。2．癫痫患儿用LTG治疗6个月后VIQ、PIQ、FIQ及各项分测验得分较用药前无明显变化（Pa〉0．05）；癫痫患儿用VPA治疗6个月后VIQ、PIQ、FIQ无明显变化（Pa〉0．05），而在分测验中知识项得分用药后比用药前显著提高（P〈0．05），编码、木块图项得分显著下降（Pa〈0．05）。结论：癫痫患儿易发生认知功能损害，且损害无选择性；癫痫患儿服用LTG 6个月后对认知功能无影响；服用VPA 6个月后FIQ未见明显变化，但在木块图和编码上有降低，而在知识项得分用药后比用药前提高，表明VPA主要影响右脑功能，而对左脑无影响。     

Breast milk feeding and cognitive ability at 7-8 years

OBJECTIVE: To examine the association between duration of breast milk feeding and cognitive ability at 7-8 years in a birth cohort of very low birthweight infants. DESIGN: 280 survivors from a national birth cohort of 413 New Zealand very low birthweight infants born in 1986 were assessed at age 7-8 years on measures of verbal and performance intelligence quotient (IQ) using the WISC-R. At the same time mothers were questioned as to whether they had elected to provide expressed breast milk at birth and the total duration of breast milk feeding. RESULTS: Some 73% of mothers provided expressed breast milk and 37% breast fed for four months or longer. Increasing duration of breast milk feeding was associated with increases in both verbal IQ (p < 0.001) and performance IQ (p < 0.05): children breast fed for eight months or longer had mean (SD) verbal IQ scores that were 10.2 (0.56) points higher and performance IQ scores that were 6.2 (0.35) points higher than children who did not receive breast milk. These differences were substantially reduced after control for selection factors associated with receipt of breast milk. Nevertheless, even after control for confounding, there remained a significant (p < 0.05) association between duration of breast milk feeding and verbal IQ: children breast fed for eight months or longer had adjusted mean (SD) verbal IQ scores that were 6 (0.36) points higher than the scores of those who did not receive breast milk. CONCLUSIONS: These findings add to a growing body of evidence to suggest that breast milk feeding may have small long term benefits for child cognitive development.     

Caudate and hippocampal volumes, intelligence, and motor impairment in 7-year-old children who were born preterm

Children who survive very preterm birth without major disability have a high prevalence of learning difficulty, attention deficit, and minor motor impairment (MMI). To determine whether these difficulties are associated with structural brain abnormalities, we studied 105 preterm children (<32 wk) at 7 y with tests of IQ and MMI (Movement ABC) and detailed magnetic resonance brain scans. Scans were assessed qualitatively for visible cerebral lesions. Volume measurements of the caudate nuclei and hippocampal formations were made. Total brain volume (TBV) was estimated from the head circumference. Qualitative assessment of the scans showed evidence of cerebral lesions in 20 (19%), which were associated with lower IQ and more frequent MMI. IQ correlated with right and left caudate volume (Spearman's rho 0.304 and 0.349; p < 0.01). This association persisted (except for verbal IQ) when caudate volume was expressed as a percentage of estimated TBV to allow for overall brain size. No significant correlations with hippocampal volumes were observed. These differences persisted when only scans from children without visible lesions on scan were considered. MMI was significantly associated only with TBV and was more common in children with evidence of thinning of the posterior corpus callosum, although most children with MMI have a normal corpus callosum. Lower IQs in children who were born preterm are related to poorer development of the caudate relative to the rest of the brain, independent of other lesions. These findings suggest abnormal brain development after perinatal injury or postnatal nutritional deficits is responsible for cognitive deficits in preterm children.     

Long-term outcome of preterm infants discharged home on kangaroo care in a developing country

Several hospital-based studies have shown the beneficial effect of kangaroo care on preterm infants. Long-term outcome was studied in 297 preterm infants born at Harare Hospital weighing 500-1800 g, discharged home on kangaroo care and followed up for 12 months. Of these, 79 (26.6%) died, 141 (47.5%) survived to complete follow-up and 77 (25.9%) were lost to follow-up. Of those who died, median birthweight was 1460 g, median age at hospital discharge 7 days, median weight at discharge 1400 g and median age at death 66 days. Of those who completed follow-up, median birthweight was 1575 g, median age at hospital discharge was 6 days and median weight at hospital discharge was 1500 g. Of those who were lost to follow-up, median age at loss to follow-up was 70 days, median birthweight was 1540 g, median age at hospital discharge was 5 days and median weight at hospital discharge was 1500 g. The hospital re-admission rate was 22.9% with 8.8% mortality. Maternal mortality and chronic morbidity rates were 4.7% and 7.4%, respectively. On comparing those who died with those who completed follow-up, mother's age <20 years, birthweight <1500 g and maternal mortality and chronic morbidity were significant risk factors for infant mortality. Age at discharge and weight at birth and on discharge were not significantly associated with infant mortality.     

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??Objective The intellectual profiles of children with AS were studied in order to better interpret their behavioral characteristics.Methods Totally 114 children of 6.08~14.24 years old with AS were examined by the China-Wechsler Intelligence Scale for Children ??C-WISC?? and all subtests were administrated.Results The level of intelligence of chidren ranged from mildly impaired to very superior??the average verbal intelligence quotient????VIQ????performance intelligence quotient??PIQ??and full intelligence quotient??FIQ?? were respectively 101.52±18.72??88.30±17.40 and 94.90±17.75??There was statistically significant difference between the VIQ and PIQ among children with AS and a tendency of VIQ??PIQ was showed??P??0.01??. The differences between scores on three Kaufman factors was significant??P??0.01??. Children with AS scored the highest on similarity??vocabulary and information subtests and scored the lowest on picture completion??picture arrangement and coding subsets in full scale??score on comprehension subtest was the lowest in the verbal scale and scores on block design and object assembly subtest were the highest in performance scale.Conclusion The intelligence structures of children with AS are not balanced??which is characterized by a combination of assets and deficits.     

Parental factors in cognitive outcome of non-handicapped low birthweight infants.

A population based cohort of 144 children weighing less than 2000 g who were without major handicap, and a random control sample of 163 children born at term and weighing over 3000 g were investigated. The aim was to assess the relative importance for cognitive development at 5 years of age, of birthweight, parental demographic factors, and factors related to the environment in which the child was reared. The mean non-verbal IQ was 6.1 points lower (95% CI, 2.3 to 10) for the low birthweight (LBW) group, but the difference was reduced to 4.8 points (95% CI, 1.1 to 8.5) after adjusting for confounding parental demographic and childrearing factors. The verbal IQ was similar for the two groups after such adjustment. Paternal education was the main confounding variable, and demographic factors such as parental education and family income were much stronger predictors of child IQ than birthweight or factors related to the childrearing environment. There was no evidence that the cognitive development of low birthweight children was more sensitive to a non-optimal childrearing environment than that of normal birthweight children. These findings indicate that the risk of impaired cognitive development increases with decreasing socioeconomic status, and that this risk is much larger than, and independent of, the small risk attributable to low birthweight.     

Pre-eclampsia—An additional risk factor for cognitive impairment at school age after intrauterine growth restriction and very preterm birth

Objective

To explore the possible influence of pre-eclampsia on cognitive outcome in children born very preterm after intrauterine growth restriction (IUGR) and abnormal umbilical artery blood flow.

Methods

Cognitive function was evaluated at 5–8 years of age with Wechsler scales in 34 children born before 30 gestational weeks after IUGR (PT-IUGR) (11 children were exposed to maternal pre-eclampsia, 23 non-exposed) and in 34 children with no maternal pre-eclampsia and birth weight appropriate-for-gestational age (PT-AGA) matched for gestational age at birth, gender and age at examination.

Results

The subjects in the PT-IUGR group exposed to maternal pre-eclampsia had lower mean verbal IQ (VIQ) (mean ± SD 74 ± 16) and lower full scale IQ (FSIQ) (70 ± 19) in comparison with both the non-exposed PT-IUGR (VIQ 89 ± 15; p = 0.013; FSIQ 83 ± 14, p = 0.029), and, the PT-AGA group (VIQ 96 ± 15, p < 0.001; FSIQ 90 ± 14, p = 0.001). The differences remained significant after adjustment for known confounders. VIQ and FSIQ did not differ between the non-exposed IUGR and PT-AGA children.

Conclusion

Fetal exposure to maternal pre-eclampsia seems to have an additional negative impact to that of IUGR on cognitive function in children born very preterm.