Home About us Contact
|
Home About us Contact | ||
|
|
||
Preterm Children (preterm + child)
Kinds of Preterm Children Selected AbstractsCognitive function at 10 years of age in children who have required neonatal intensive careACTA PAEDIATRICA, Issue 12 2004L Schermann Aim: To study cognitive function at 10 y of age in a cohort of children who required neonatal intensive care within the Uppsala Neonatal Follow-up Study. Methods: 226 children, who were born in 1986,1989 and had required neonatal intensive care (NIC) and 72 full-term, healthy control children were enrolled in the study. NIC children were grouped according to gestational age (group I, 23,31 wk; subgroup IA, 23,27 wk; IB 28,31 wk; group II, 32,36 wk; group III, >36wk), with infants with congenital malformation (IWCM) included and excluded from the main groups. The Kaufman Assessment Battery for Children (K-ABC) was administered and results were analysed in relation to the K-ABC global scales: sequential, simultaneous, mental processing composite and achievement. Results: The great majority of children had well-developed cognitive function, reaching scores at an average level or above. When groups were compared, full-term children that required NIC (group III) showed lower scores than controls on all scales measured by the K-ABC. Preterm children from all the studied groups (groups IA, IB, II) showed poorer performance than controls in the simultaneous processing scale, and group IA scored lower than controls in the achievement scale. The incidence of major cognitive impairment (IQ <70) was low in NIC children (<5%), but children from group IA showed significant higher frequency of impairment in the simultaneous, mental processing composite and achievement scales. Children from group IA presented a high frequency of discrepancy between the K-ABC scales, with lower simultaneous and higher sequential scores. Analysis with IWCM excluded from the main groups revealed identical results. Conclusion: Most children who needed neonatal intensive care had developed well their cognitive function at 10 y of age. The long-term effect of neonatal intensive care on cognitive function was more evident in extremely preterm infants (group IA), especially in tasks involving simultaneous ways of processing information. [source] Patterns of motor disability in very preterm childrenDEVELOPMENTAL DISABILITIES RESEARCH REVIEW, Issue 4 2002Melanie Bracewell Abstract Motor development in very preterm children differs in several important ways from that of children born at full term. Variability is common, although the anatomic and physiologic bases for that variability are often poorly understood. Motor patterns over the first postnatal year may depend on behaviours learned during often long periods of neonatal intensive care. The normal pattern of development may be modified by disturbances of brain function caused both by the interruption of normal brain maturation ex-utero and the superimposition of focal brain injuries following very preterm birth. Abnormal patterns of development over the first year may evolve into clear neuromotor patterns of cerebral palsy or resolve, as "transient dystonias." Cerebral palsy is associated with identified patterns of brain injury secondary to ischaemic or haemorrhagic lesions, perhaps modified by activation of inflammatory cytokines. Cerebral palsy rates have not fallen as might be expected over the past 10 years as survival has improved, perhaps because of increasing survival at low gestations, which is associated with the highest prevalence of cerebral palsy. Children who escape cerebral palsy are also at risk of motor impairments during the school years. The relationship of these impairments to perinatal factors or to neurological progress over the first postnatal year is debated. Neuromotor abnormalities are the most frequent of the "hidden disabilities" among ex-preterm children and are thus frequently associated with poorer cognitive ability and attention deficit disorders. Interventions to prevent cerebral palsy or to reduce these late disabilities in very preterm children are needed. MRDD Research Reviews 2002;8:241,248. © 2002 Wiley-Liss, Inc. [source] Do healthy preterm children need neuropsychological follow-up?DEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 10 2010Preschool outcomes compared with term peers Aim, The aim of this study was to determine neuropsychological performance (possibly predictive of academic difficulties) and its relationship with cognitive development and maternal education in healthy preterm children of preschool age and age-matched comparison children born at term. Method, A total of 35 infants who were born at less than 33 weeks' gestational age and who were free from major neurosensory disability (16 males, 19 females; mean gestational age 29.4wk, SD 2.2wk; mean birthweight 1257g, SD 327g) and 50 term-born comparison children (25 males, 25 females; mean birthweight 3459g, SD 585g) were assessed at 4 years of age. Cognition was measured using the Griffiths Mental Development scales while neuropsychological abilities (language, short-term memory, visual,motor and constructive spatial abilities, and visual processing) were assessed using standardized tests. Multivariable regression analysis was used to explore the effects of preterm birth and sociodemographic factors on cognition, and to adjust neuropsychological scores for cognitive level and maternal education. Results, The mean total Griffiths score was significantly lower in preterm than in term children (97.4 vs 103.4; p<0.001). Factors associated with higher Griffiths score were maternal university education (,=6.2; 95% confidence interval [CI] 0.7,11.7) and having older siblings or a twin (,=4.0; 95% CI 0.5,7.6). At neuropsychological assessment, preterm children scored significantly lower than term comparison children in all tests except lexical production (Boston Naming Test) and visual-processing accuracy. After adjustment for cognitive level and maternal education, differences remained statistically significant for verbal fluency (p<0.05) and comprehension, short-term memory, and spatial abilities (p<0.01). Interpretation, Neuropsychological follow-up is also recommended for healthy very preterm children to identify strengths and challenges before school entry, and to plan interventions aimed at maximizing academic success. [source] Eating problems at age 6 years in a whole population sample of extremely preterm childrenDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 2 2010MUTHANNA SAMARA Aim, The aim of this study was to investigate the prevalence of eating problems and their association with neurological and behavioural disabilities and growth among children born extremely preterm (EPC) at age 6 years. Method, A standard questionnaire about eating was completed by parents of 223 children (125 males [56.1%], 98 females [43.9%]) aged 6 years who were born at 25 weeks' gestation or earlier (mean 24.5wks, SD 0.7wks; mean birthweight 749.1g, SD 116.8g), and parents of 148 classmates born at term (66 males [44.6%], 82 females [55.4%]). All children underwent neurological, cognitive, and anthropometric assessment, and parents and teachers completed a behaviour scale. Results, Eating problems were more common among the EPC than the comparison group (odds ratio [OR] 3.6, 95% confidence interval [CI] 2.1,6.3), including oral motor (OR 5.2, 95% CI 2.8,9.9), hypersensitivity (OR 3.0, 95% CI 1.6,5.6), and behavioural (OR 3.8, 95% CI 1.9,7.6) problems. Group differences were reduced after adjustment for cognitive impairment, neuromotor disability, and other behaviour problems. EPC with eating problems were shorter, lighter, and had lower mid-arm circumference and lower body mass index (BMI) even after adjusting for disabilities, gestational age, birthweight, and feeding problems at 30 months. Interpretation, Eating problems are still frequent in EPC at school age. They are only partly related to other disabilities but make an additional contribution to continued growth failure and may require early recognition and intervention. [source] Cognitive visual dysfunctions in preterm children with periventricular leukomalaciaDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 12 2009ELISA FAZZI MD PHD Aim, Cognitive visual dysfunctions (CVDs) reflect an impairment of the capacity to process visual information. The question of whether CVDs might be classifiable according to the nature and distribution of the underlying brain damage is an intriguing one in child neuropsychology. Method, We studied 22 children born preterm (12 males, 10 females; mean age at examination 8y, range 6,15y; mean gestational age 30wks, range 28,36wks) with periventricular leukomalacia, spastic diplegia, normal intelligence (mean Full-scale IQ 84; mean Verbal IQ 97; mean Performance IQ 74), and normal visual acuity, focusing on higher visual functions. Brain magnetic resonance images (MRI) were analysed to establish the presence of lesions along the primary optic pathway, in the occipitoparietal and occipitotemporal regions. Results, Most children displayed an uneven cognitive profile, with deficits in visual object recognition, visual imagery, visual,spatial skills, and visual memory, and sparing of visual associative abilities, non-verbal intelligence, and face and letter recognition. Conventional brain MRI did not document major alterations of parietal and temporal white matter, or cortical alteration of areas involved in visual associative functions. Interpretation, We suggest a widespread involvement of higher visual processing systems, involving both the ventral and dorsal streams, in preterm children with periventricular leukomalacia. The lack of major alterations on conventional MRI does not exclude the possibility of malfunctioning of higher visual processing systems, expressing itself through discrete CVDs. Possible mechanisms underlying these neuropsychological deficits are discussed. [source] Factors affecting vocabulary acquisition at age 2 in children born between 23 and 28 weeks' gestationDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 8 2007Louise Marston MSc Language development is often slower in preterm children compared with their term peers. We investigated factors associated with vocabulary acquisition at 2 years in a cohort of children born at 28 weeks' gestation or less. For children entered into the United Kingdom Oscillation Study, language development was evaluated by using the MacArthur-Bates Communicative Development Inventories score, completed by parents as part of a developmental questionnaire. The effect of demographic, neonatal, socioeconomic factors, growth, and disability were investigated using multifactorial random effects modelling. Questionnaires were returned by 288 participants (148 males, 140 females). The mean number of words vocalized was 42 (SD 29). Multifactorial analysis showed only four factors were significantly associated with vocabulary acquisition. These were: (1) level of disability (mean words: no disability, 45; other disability, 38; severe disability, 30 [severe disability is defined as at least one extreme response in one of the following clinical domains: neuromotor, vision, hearing, communication, or other physical disabilities]; 95% confidence interval [CI] for the difference between no and severe disability 7- 23); (2) sex (39 males, 44 females; 95% CI 0.4-11); (3) length of hospital stay (lower quartile, 47; upper quartile, 38; 95% CI -12 to -4); and (4) weight SD score at 12 months (lower quartile, 39; upper quartile, 44; 95% CI 1,9). There was no significant association between gestational age and vocabulary after multifactorial analysis. There was no significant effect of any socioeconomic factor on vocabulary acquisition. We conclude that clinical factors, particularly indicators of severe morbidity, dominate the correlates of vocabulary acquisition at age 2 in children born very preterm. [source] Victimization: a newly recognized outcome of prematurityDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 8 2004Line Nadeau PhD Victimization by peers affects 10 to 20% of school children under the age of 12 years. Physical, verbal, and psychological victimization (being pushed, hit, called names, teased, being the target of rumours, theft, extortion) is associated with short- and long-term adjustment problems, such as peer rejection, social withdrawal, low self-esteem, anxiety, loneliness, and depression, as well as academic problems and school drop-out. Research on populations of school children (primary and secondary) has associated victimization with personal risk factors (the victim's characteristics and behaviour) and interpersonal risk factors (social relationships between peers). Studies on the social adjustment of preterm children at school age show that, even in the absence of a major motor or cognitive disability, this population has several personal risk factors associated with victimization. The objective of this study was to compare the level of victimization experienced by a group of 96 seven-year-old children born extremely preterm (EP, <29 weeks of gestation; 49 females) against that experienced by a group of 63 term children (34 females) matched for age and sex, maternal level of education, and family socioeconomic status. The children born EP had a mean gestational age of 27.3 weeks (SD 1.2) and a mean birthweight of 1001.1g (SD 223) and normal birth weight children had a mean gestational age of 39.5 weeks (SD 1.5) and a mean birthweight of 3468.7g (SD 431). Physical and verbal victimization were assessed in a school setting by peers with individual sociometric interviews (Modified Peer Nomination Inventory). After controlling for physical growth (height and weight) at the age of 7 years, the data indicate two independent effects: males were more victimized than females, and children born preterm experienced more verbal victimization by their peers than their term classmates, even when participants with a visible motor, intellectual, or sensory disability were excluded. Several hypotheses are presented to account for the higher incidence of verbal victimization of preterm children. [source] Ophthalmological, cognitive, electrophysiological and MRI assessment of visual processing in preterm children without major neuromotor impairmentDEVELOPMENTAL SCIENCE, Issue 5 2010Michelle O'Reilly Many studies report chronic deficits in visual processing in children born preterm. We investigated whether functional abnormalities in visual processing exist in children born preterm but without major neuromotor impairment (i.e. cerebral palsy). Twelve such children (< 33 weeks gestation or birthweight < 1000 g) without major neuromotor impairment and 12 born full-term controls were assessed at 8,12 years of age by means of ophthalmological assessment (visual acuity, colour vision, stereopsis, stereoacuity, visual fields, ocular motility, motor fusion), cognitive tests of visual-motor, visual-perceptual and visual-spatial skills and pattern-reversal visual evoked potentials (PR-VEPs). All participants also underwent magnetic resonance imaging (MRI) of the brain and neuromotor assessments. No significant differences were found between the groups on the ophthalmological, visual cognitive, neurological, neuromotor or MRI measures. The P100 component of the PR-VEP showed a significantly shorter latency in the preterm compared with the full-term participants. Whilst this P100 finding suggests that subtle abnormalities may exist at the neurophysiological level, we conclude that visual dysfunction is not systematically associated with preterm birth in the context of normal neurological status. [source] Developmental evaluation at age 4: Validity of an Italian parental questionnaireJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 7-8 2010Anna Maria Dall'Oglio Aim: To validate an Italian parental questionnaire designed to evaluate the neuropsychological and behavioural developmental status of 4-year-olds and identify children in need of further evaluation. Methods: The questionnaire (Questionario per la valutazione dello Sviluppo di bambini a 4 anni , Genitori (QS4-G) ) consisted of 93 questions divided into 10 areas: language, visual-motor abilities, memory/attention, fine and gross motor and self-help abilities, lateralisation, social skills, stress, sleep, alimentation and evacuation. It was distributed to 263 parents of 4-year-olds: 94 healthy preterm (gestational age <33 weeks and/or <1500 g, without major neurosensory damage); 44 children with developmental disorders and 125 children with typical development. Cognitive and neuropsychological evaluations were performed using standardised tests. Results: The internal consistency of the areas was adequate (Cronbach's alpha: 0.69,0.79). The correlation coefficients (r=|0.30|,|0.68|) with standardised tests (Griffiths, Vineland and neuropsychological tests) indicated a good concurrent validity. The receiver operating characteristic curve, for predicting a Griffiths Quotient less than 81, showed an area under the curve of 0.90 and a high diagnostic and discriminatory capacity (sensitivity of 0.88 and specificity of 0.84) for the optimal cut-off (value 48.4). Conclusion: The QS4-G seems to be a valid tool for identifying 4-year-old children at risk for low or borderline cognitive development and/or problematic behaviour who need a complete assessment. It can describe individual neuropsychological profiles. QS4-G is not a diagnostic tool. It is useful for outcome studies in preterm children and in other pathologies. It could also be useful for preschooler prevention programmes. [source] Chronic lung disease of prematurity and respiratory outcome at eight years of ageJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 1-2 2007Karthikeyan Kulasekaran Aim: The study aimed to determine the respiratory outcome of children who had chronic lung disease of prematurity (CLD) compared with a preterm control group of children at school age. Methods: Fifty-two preterm infants with CLD born between 26 and 33 weeks gestation were assessed regarding respiratory illness with 47 having lung function testing. Information regarding respiratory illness was obtained from 52 children in the birthweight-matched control group of whom 45 had lung function testing. The results were compared between the CLD and control groups. Results: There was no difference in respiratory symptomatology between CLD groups and control preterm infants. On lung function testing, a significantly lower mean forced expiratory flow at 25,75% of vital capacity was identified compared with the preterm controls (P = 0.024). This significant difference did not persist after bronchodilator therapy. There was no evidence of increased air trapping or bronchial hyper-reactivity in the CLD children compared with the controls. Conclusion: Lung function in CLD children is largely normal in comparison with preterm controls, apart from some evidence of reversible small airway obstruction. Respiratory symptomatology is not increased in chronic disease children in comparison with control preterm children. [source] Methylxanthines and sensorineural outcome at 14 years in children < 1501 g birthweightJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 1 2000PG Davis Objectives: Methylxanthines, including theophylline, have been used extensively and successfully to treat apnoea in preterm infants. However, long-term consequences of such therapy are largely unknown. The aim of this study was to determine the relationship between theophylline therapy and outcome at 14 years of age in surviving preterm children of birthweight < 1501 g. Methodology: The subjects of this study were 154 consecutive survivors with birthweights < 1501 g born from 1 October 1980 to 31 March 1982; 130 (84.4%) were assessed at 14 years of age. Outcomes included motor function, psychological test scores, and growth. Results: Of the 130 children assessed, 69 (53.1%) had been exposed to theophylline; 13.0% had cerebral palsy, significantly higher than 1.6% in the 61 children not exposed to theophylline (P < 0.02). This difference remained statistically significant after adjusting for potential confounding variables including the presence of cerebroventricular haemorrhage. In contrast, after adjusting for known confounding variables, children who had received theophylline achieved higher psychological test scores. There was no association between theophylline therapy and growth. Conclusions: Theophylline therapy in the newborn period is associated with some evidence of harmful, but also helpful sensorineural effects at 14 years of age. [source] Detection of Childhood Visual Impairment in At-Risk GroupsJOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES, Issue 3 2007Heleen Evenhuis Abstract, Children with intellectual disabilities have an increased risk of visual impairment, caused by both ocular and cerebral abnormalities, but this risk has not been quantified. The same applies to preterm children and children with cerebral palsy with a normal intelligence. Many cases probably go unidentified, because participation of these children in preschool vision screening programs is not guaranteed, or because no screening program is available. Although there may be a case for specific screening, there is insufficient scientific evidence supporting such a claim. A "safety net" construction for vision screening is proposed by a Dutch expert working party, based on scientific information and joint professional expertise, to improve identification of both ocular and cerebral visual impairment in at-risk groups. Costs and gains of the model should be scientifically evaluated in a test region. [source] Altered inflammatory responses in preterm children with cerebral palsyANNALS OF NEUROLOGY, Issue 2 2010Chang-Yi Lin BS Objective Perinatal inflammatory responses contribute to periventricular leukomalacia (PVL) and cerebral palsy (CP) in preterm infants. Here, we examined whether preterm children with CP had altered inflammatory responses when school-aged. Methods Thirty-two preterm children with PVL-induced CP (mean [±standard deviation] age, 7.2 ± 3.6 years) and 32 control preterm children with normal neurodevelopment (6.2 ± 2.2 years) and matched for gestational age were recruited. We measured tumor necrosis factor (TNF)-, levels in the plasma and the supernatants of peripheral blood mononuclear cells (PBMCs) before and after lipopolysaccharide (LPS) stimulation, and proinflammatory gene expression in the PBMCs. Results TNF-, expression was significantly higher in the plasma (p < 0.001) and supernatants of LPS-stimulated PBMCs (p = 0.003) in the CP group than in the control group. After LPS stimulation, the intracellular TNF-, level in the PBMCs was significantly lower in the control group (p = 0.016) and significantly higher in the CP group (p = 0.01). The CP group also had, in their nonstimulated PBMCs, significantly higher mRNA levels of inflammatory molecules: toll-like receptor 4 (TLR-4) (p = 0.0023), TNF-, (p = 0.0016), transforming growth factor-,,activated kinase 1 (p = 0.038), I,B kinase-, (p = 0.029), and c-Jun N-terminal kinase (p = 0.045). The TLR-4 mRNA levels in the PBMCs were highly correlated with TNF-, levels in LPS-stimulated PBMCs (Spearman rank correlation = 0.38, p = 0.03). Interpretation The finding that preterm children with PVL-induced CP have altered inflammatory responses indicates the possibility of programming effect of PVL or inflammation-related events during early life. ANN NEUROL 2010;68:204,212 [source] Preterm and at term children: morphological and functional analysis of optic nerve and visual pathway with OCT, HRT and pVEPACTA OPHTHALMOLOGICA, Issue 2009R ANGELI Purpose To compare optic nerve morphology and visual function in 14 preterm children(mean gestational age:33,38) with normal cerebral ultrasound at birth and 15 at term children (mean gestational age:39,67). Methods Mean preterm age was 7,6 years, mean at term was 9,1 years. Children underwent to complete functional and morphological evaluation of Optic Nerve Head (ONH) with Heidelberg Retinal Tomography and Optical Coherence Tomography. The same children were evaluated at birth and at the time of morphological examinations by mean of transient and steady state pVEP. Results Mean visual acuity was 9,85 in the preterm, 10 in the at term children. HRT in preterm and at term children at term(n=28) preterm(n=25) P value mean sd mean sd Disc Area 2,5 0,7 2,34 0,68 0,38 Cup Area 0,50 0,44 0,58 0,47 0,51 Rim Area 2 0,45 1,76 0,37 0,047 C/D Area Ratio 0,18 0,12 0,22 0,14 0,23 C/D Linear Ratio 0,4 0,15 0,45 0,16 0,30 Mean RNFL Thick 0,2 0,07 0,24 0,2 0,26 Tab.1 A statistically significant reduction was found in preterm children as regard rim area (p=0,047,tab 1) at HRT and superior RNFL thickness (p=0,01), temporal and inferior inner macular thickness (p=0,03) at OCT. Differences in the pVep latencies were found at 3 and 8 months after birth, but not at the time of morphological examination. Steady State pVEP amplitudes differences were not statistically significant. Conclusion Morphologic optic disk and macula differences between term and preterm children seems not functionally affect the visual pathway. [source] Early postnatal growth variables are related to morphologic and functional ophthalmologic outcome in children born pretermACTA PAEDIATRICA, Issue 5 2010M Hök-Wikstrand Abstract Aim:, To evaluate the association between gestational age (GA), early and late postnatal growth variables and ophthalmologic outcome in ex-preterm children. Methods:, Children (GA < 32 weeks, n = 66), previously examined regarding insulin-like growth factor 1 (IGF-1) serum concentrations in relation to ROP, underwent ophthalmologic examination at median 5.6 years. Weight, height, and head circumference (HC) were measured and expressed as SDS. Growth variables were analysed in relation to ophthalmologic outcome. Results:, At follow-up 74% had some ophthalmologic abnormality and 17% had visual impairment. Poor visual acuity was correlated with low GA (rs = 0.29, p = 0.019), low weight at 32 weeks (rs = 0.30, p = 0.013), and low weight (rs = 0.37, p = 0.0025), height (rs = 0.41, p = 0.0007) and HC (rs = 0.55, p < 0.0001) at follow-up. Hyperopic children (25%) had low neonatal IGF-1 (p = 0.0096) and HC at follow-up (p = 0.022). Poor visual perception was correlated with low early weight (rs = 0.38, p = 0.0036) and HC at follow-up (rs = 0.39, p = 0.0024). Head circumference at follow-up was correlated with GA (rs = 0.40, p = 0.0012), neonatal IGF-1 (rs = 0.37, p = 0.0031), and early weight (rs = 0.27, p = 0.035). Conclusions:, In very preterm children, early and later postnatal growth is closely related to visual acuity and perception at follow-up. In addition, IGF-1 concentrations and early growth are correlated with head circumference and refraction at follow-up. [source] Neurodevelopment of children born very preterm and free of severe disabilities: the Nord-Pas de Calais Epipage cohort studyACTA PAEDIATRICA, Issue 5 2010ML Charkaluk Abstract Aim:, To describe the development of very preterm children free of cerebral palsy or severe sensory impairment in the domains of gross and fine motor functions, language and sociability at a corrected age of 2 years; to identify factors associated with performances in each domain. Methods:, A total of 347 children born in 1997 before 33 weeks of gestation, part of the EPIPAGE population-based cohort study, had their psychomotor development assessed with the Brunet-Lezine scale. Results:, The study population had a mean gestational age of 30.1 ± 2.0 weeks. Lower developmental quotients (DQ) were observed in the study group compared to the reference sample (96 ± 13 vs 104 ± 8, p < 0.01). Fine motor function, language and sociability were all affected with a p value <0.01. Multivariate analysis showed that duration of intubation and parents' educational and occupational levels were the only variables significantly related to each developmental domain (p < 0.01). Conclusions:, Children very preterm and free of severe disabilities had mild delays in multiple areas of development. The mechanisms by which neonatal factors played a role need further investigation. However socioeconomic status had a great impact on development and our results underline the need for improved support of socioeconomically disadvantaged parents after a preterm birth. [source] IPD meta-analysis shows no effect of LC-PUFA supplementation on infant growth at 18 monthsACTA PAEDIATRICA, Issue 1 2009Eva Rosenfeld Abstract Aim: Clinical trials on the effects of long-chain polyunsaturated fatty acids (LC-PUFA) supplementation of formula milk on growth of term and preterm children have shown conflicting results. We examined the effects of LC-PUFAs , especially docosahexaenoic acid (DHA) and arachidonic acid (AA) , on growth at 18 months. Methods: We performed a meta-analysis based on individual patient data (IPD) of 901 children from four large, randomised clinical trials of formula milk with and without LC-PUFAs. Anthropometrics were assessed by z-scores based on weight for age, length for age, head circumference for age and body mass index (BMI) for age at 18 months. The studies differed in LC-PUFA composition and infant characteristics (two studies on preterm children, two on term children). Results: Multivariate regression analyses including the possible confounders, sex, gestational age, birth weight, smoking in the last trimester and maternal age, as well as interaction terms showed no significant effects of LC-PUFA supplementation on any z-score. Subgroup analyses on trials with high amounts of DHA and on studies with duration of supplementation of at least 6 months yielded the same result. These findings cannot be explained by the lack of power. Conclusion: Our IPD meta-analysis shows no evidence that LC-PUFA supplementation affects children's growth at 18 months of age. [source] Sleep behaviour in preterm children from birth to age 10 years: A longitudinal studyACTA PAEDIATRICA, Issue 12 2006IVO IGLOWSTEIN Abstract Aim: To study clinically relevant aspects of sleep behaviour in preterm children in comparison to term children. Methods: Longitudinal sleep behaviour data were collected prospectively by structured interviews in 130 preterm and 75 control term children from birth to age 10 y. Results: No significant differences in sleep duration (time in bed per 24 h), bedsharing, night wakings, bedtime resistance and sleep-onset difficulties were found between preterm and term children. Conclusion: Sleep behaviour does not differ between preterm and term children from birth to age 10 y, indicating that prematurity or neonatal intensive care experience does not significantly affect sleep in the first 10 y of life. [source] The effect of growth hormone treatment on metabolic and cardiovascular risk factors is similar in preterm and term short, small for gestational age childrenCLINICAL ENDOCRINOLOGY, Issue 1 2009Sandra W. K. De Kort Summary Context, We previously reported that short, small for gestational age (SGA) children who were born preterm have a lower body fat percentage and a higher blood pressure, insulin secretion and disposition index than short SGA children born at term. Whether preterm birth also influences these parameters during GH treatment is unknown. Objective, To compare blood pressure, insulin sensitivity, beta-cell function and body composition during 4 years of GH treatment, between preterm and term short SGA children. Patients, A total of 404 prepubertal non-GH-deficient short SGA children were divided into 143 preterm (< 36 weeks) and 261 term children. Outcome measures, Height, blood pressure (n = 404), body composition measured by dual energy X-ray absorptiometry (DXA) (n = 138) and insulin sensitivity and beta-cell function calculated from a frequent sampling intravenous glucose tolerance test (FSIGT) with tolbutamide (n = 74) or from the homeostasis model assessment of insulin resistance (HOMA-IR) (n = 204). Results, In preterm and term children, GH treatment resulted in a similar decrease in systolic and diastolic blood pressure, body fat percentage, limb fat/total fat ratio and insulin sensitivity, and a similar increase in insulin secretion and disposition index. Lean body mass (LBM) corrected for gender and height increased in term children and did not change in preterm children. Multiple regression analysis revealed that this difference in GH effect on LBM was not associated with gestational age. Conclusion, The effect of GH treatment on metabolic and cardiovascular risk factors is similar in preterm and term short, SGA children. [source] Perinatal risk factors of adverse outcome in very preterm children: a role of initial treatment of respiratory insufficiency?ACTA PAEDIATRICA, Issue 2 2004B Mølholm Hansen Aim: To investigate risk factors of adverse outcome in a cohort of very preterm children treated mainly with nasal continuous positive airway pressure (CPAP) during the neonatal course. Methods: In Denmark, preterm children are treated with nasal CPAP as a first approach to respiratory support. A national prospective study of all infants with a birthweight below 1000 g or a gestational age below 28 wk born in 1994,1995 was initiated to evaluate this approach. Of the 269 surviving children 164 (61%) were not treated with mechanical ventilation in the neonatal period. A follow-up of the children at 5 y of age was conducted. Data from the neonatal period and the 5-y follow-up were analysed. Results: In multivariate analyses including 250 children, a severely abnormal neonatal brain ultrasound scan was predictive of cerebral palsy (OR= 19.9, CI 95%: 6.1,64.8) and intellectual disability (OR = 6.2, CI 95%: 2.3,16.5). A high Clinical Risk Index for Babies (CRIB) score (OR = 2.4, CI 95%: 1.1,5.5) and chronic lung disease (OR = 2.8, CI 95%: 1.2,6.9) were predictive of intellectual disability. In univariate analyses mechanical ventilation was associated with cerebral palsy (OR = 4.3, CI 95%: 1.7,10.8) and intellectual disability (OR = 2.2, CI 95%: 1.2,4.2), but the associations became insignificant in multivariate analyses including chronic lung disease and a severely abnormal ultrasound scan. Conclusion: The associations between neonatal risk factors and adverse outcome in our cohort were very similar to those found in other cohorts with another initial treatment of respiratory insufficiency. We found no significant adverse effects of mechanical ventilation beyond what could be explained by associations with chronic lung disease and IVH 3,4/PVL. [source] Early nasal continuous positive airway pressure in a cohort of the smallest infants in Denmark: neurodevelopmental outcome at five years of ageACTA PAEDIATRICA, Issue 2 2004BM Hansen Aim: To evaluate neurodevelopmental outcome at age 5 y of age in a cohort of preterm children treated mainly with nasal continuous positive airway pressure (CPAP) in the neonatal period. Methods: A national prospective observational study was conducted in Denmark which included all 269 surviving children with a birthweight below 1000 g or a gestational age below 28 wk born in Denmark in between 1994 and 1995. A total of 164 children (61%) had been treated with nasal CPAP only in the neonatal period. A reference group (n= 76) of term children was studied in parallel. Results: Of the 269 surviving children, 252 (94%) were examined. Twenty-four children (10%) had cerebral palsy, and three children were blind. No case of hearing impairment was detected. Nineteen percent of the index children had an IQ score >-2 SD and 42% had an IQ score >-1 SD of the mean score of the reference group. Conclusions: The intellectual development of children in this cohort treated with early nasal CPAP did not suggest a higher proportion of adverse effects on the brain compared to the published follow-up studies of preterm children treated with mechanical ventilation. In our population-based cohort, however, the survival rate for infants below 25 wk of gestation was relatively low and this may indicate a limit for the use of early nasal CPAP. [source] Treatment of extremely preterm infants: parents'attitudesACTA PAEDIATRICA, Issue 6 2003B Mølholm Hansen Aim: To conduct a survey of the attitude towards treatment of extremely preterm infants by comparing the attitude towards life-saving treatment between a group of parents of extremely preterm children and parents in the general population. The importance the two groups of respondents assigned to parental preferences was also investigated. Methods: A Danish national cohort of children born from 1994 to 1995 with a birthweight below 1000 g or a gestational age below 28 wk were assessed in a 5-y follow-up study including a reference group of children born at term. The parents of the children were given a sequence of case vignettes presenting different clinical situations, which formed part of a questionnaire. Results: More than 80% of 222 possible index respondents and 76 possible reference respondents fulfilled the vignettes. Both groups of respondents were positive towards life-saving treatment of extremely preterm infants. The recommendations given by both groups were significantly influenced by the hypothetical child's risk of having a serious handicap and the parents'preferences. The results suggest that parents of extremely preterm children do not have a more conservative attitude towards life-saving treatment of extremely preterm infants than parents in the general population, and also support the view that parents'preferences should influence treatment decisions; although many believe that these should not be decisive. Conclusion: Compared to the general population, parents of children born extremely preterm did not express a more conservative attitude towards life-saving treatment of extremely preterm infants. [source] | ||||||||||||||||||||||||||||