Home About us Contact
|
Home About us Contact | ||
|
|
||
Very Preterm Children (very + preterm_child)
Selected AbstractsPatterns 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] 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] 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] | ||||||||||