Extremely Low Birth Weight Children Research Articles

Parental perspectives of the health status and health-related quality of life of teen-aged children who were extremely low birth weight and term controls.

To compare the health status and health-related quality of life of teen-aged children who were extremely low birth weight (ELBW) with matched controls from the perspective of their parents. Geographically defined cohort; longitudinal follow-up; cross-sectional interviews. parents of 149/169 (88%) ELBW children between 12 and 16 years of age (including 41 children with neurosensory impairments) and 126/145 (87%) parents of term controls. Health status of the teenagers was classified according to the 6 attributes of the Health Utilities Index Mark 2, based on information obtained during parent interviews. Parents were asked to imagine themselves living in their own child's health state and 4 preselected hypothetical health states when providing directly measured standard gamble utility scores. Parents of ELBW children reported a higher frequency and more complex functional limitations than parents of controls for their own children's health status. Also, the mean utilities were lower (ELBW =.91 vs controls =. 97) and the variability in their scores was greater. There were no differences in the valuation of the hypothetical health states provided by parents of ELBW and control children. ELBW children were reported to have a greater burden of disability than were control children based on parental descriptions. Nonetheless, parents of ELBW children, on average, rated the health-related quality of life of their children fairly high. Thus, differences in reported functional status are not necessarily associated with lower utility scores.

School difficulties at adolescence in a regional cohort of children who were extremely low birth weight.

To compare measures of psychometric assessment and school difficulties in a cohort of extremely low birth weight (ELBW) teenagers and term controls, and to determine whether there is stability in psychometric measures between age 8 and the teen years. Longitudinal follow-up; geographically defined region. 150 of 169 (89%) ELBW survivors born between 1977 and 1982 and 124 of 145 (86%) sociodemographically matched term controls between 12 and 16 years of age. Psychometric measures: Wechsler Intelligence Scale for Children-Revised, Wide Range Achievement Test-Revised, and a validated parent questionnaire. Neurosensory impairments were present in 28% of ELBW and 1% of controls. The mean Wechsler Intelligence Scale for Children-Revised scores were ELBW: 89 +/- 19 and controls: 102 +/- 13. ELBW children did less well on Wide Range Achievement Test-Revised Reading, Spelling, and Arithmetic measures with mean scores in the range from 75 to 85. ELBW children <750 g were more disadvantaged, compared with those >/=750 g. A significantly higher proportion of ELBW children were receiving special educational assistance and/or had repeated a grade (ELBW: 58%; controls: 13%; odds ratio: 9.0). Paired analysis of within-cohort data at age 8 and teen years showed that for both cohorts Arithmetic scores declined, but there were small improvements in other measures, predominantly in the term children. Differences of 13 to 18 points in psychometric measures in ELBW teens compared with controls are both statistically significant and clinically relevant. Decreasing birth weight was associated with increased risk on all measures. The high utilization of special educational resources has economic implications, and the incremental cost attributable to being extremely premature needs to be determined.

Motor Abilities at Eight to Ten Years of Children Born Weighing Less than 1,000 g

There is increasing evidence to suggest that extremely low birthweight (ELBW) children who are otherwise normal may not perform at school as well as expected. The aim of this pilot study was to investigate the type of minor motor problems evident in children who were less than 1,000 g at birth and now in their third or fourth year at school. Twenty-nine ELBW children now aged eight to ten years, who had no sensory, cognitive or motor impairment and were attending regular school, and a comparative group of 12 normal birthweight eight-year-old children were assessed using a battery of eight tests selected to assess aspects of motor control most likely to indicate problems which could interfere with performance at school. The results showed a significant difference in overall performance between the ELBW and normal birthweight children. Significant differences in performance between the subgroup of ELBW eight-year-old children and normal birthweight eight-year-olds were found in tests of preferred hand position sense, single leg stance (left), alternate hand ball bounce and an alphabet writing task. Less than 40% of the 29 ELBW children were found to be performing overall in the expected normal range. This study concluded that ELBW children present with mild motor problems in the areas of gross and fine motor performance, postural stability and balance. There is increasing evidence to suggest that extremely low birthweight (ELBW) children who are otherwise normal may not perform at school as well as expected. The aim of this pilot study was to investigate the type of minor motor problems evident in children who were less than 1,000 g at birth and now in their third or fourth year at school. Twenty-nine ELBW children now aged eight to ten years, who had no sensory, cognitive or motor impairment and were attending regular school, and a comparative group of 12 normal birthweight eight-year-old children were assessed using a battery of eight tests selected to assess aspects of motor control most likely to indicate problems which could interfere with performance at school. The results showed a significant difference in overall performance between the ELBW and normal birthweight children. Significant differences in performance between the subgroup of ELBW eight-year-old children and normal birthweight eight-year-olds were found in tests of preferred hand position sense, single leg stance (left), alternate hand ball bounce and an alphabet writing task. Less than 40% of the 29 ELBW children were found to be performing overall in the expected normal range. This study concluded that ELBW children present with mild motor problems in the areas of gross and fine motor performance, postural stability and balance.

Neurosensory outcome and growth at three years in extremely low birthweight infants: follow‐up results from the Swedish national prospective study

A prospective national investigation comprising 633 extremely low birthweight (ELBW) infants born alive in the 2‐y period 1990‐1992 with a birthweight of ≤ 1000 g and gestational age of ≥ 23 completed weeks was conducted regarding neurosensory outcome and growth. Three‐hundred and sixty‐two (98%) surviving ELBW infants were assessed at a median age of 36 months, using a specially designed protocol. At follow‐up, mean height, weight and head circumference in both boys and girls were significantly lower than the reference values. The incidence of cerebral palsy was 7% among all children and 14%, 10% and 3% in children born at 23‐24,25‐26 and ≥ 27 gestational weeks, respectively. At least one obvious handicap was present in 14%, 9% and 3% of these three groups of children, respectively. After adjustment for gestational age, a significantly increased risk of handicap was found in children with intraventricular haemorrhage grade ≥ 3 and/or periventricular leucomalacia and in children with retinopathy of prematurity stage ≥ 3. The results show that more than 90% of ELBW children born at ≥ 25 completed gestational weeks were without neurosensory handicap at 36 months of corrected age. In infants born at 23–24 weeks of gestation, both survival and long‐term outcome were less favourable.

Children's Judgements about Pain at Age 8–10 Years: Do Extremely Low Birthweight (≤ 1000 g) Children Differ from Full Birthweight Peers?

Children's judgements about pain at age 8-10 years were examined comparing two groups of children who had experienced different exposure to nociceptive procedures in the neonatal period: extremely low birthweight (ELBW) < or = 1000 g (N = 47) and full birthweight (FBW) > or = 2500 g (N = 37). The 24 pictures that comprise the Pediatric Pain Inventory, depicting events in four settings: medical, recreational, daily living, and psychosocial, were used as the pain stimuli. The subjects rated pain intensity using the Color Analog Scale and pain affect using the Facial Affective Scale. Child IQ and maternal education were statistically adjusted in group comparisons. Pain intensity and pain affect related to activities of daily living and recreation were significantly higher than psychosocial and medically related pain on both scales in both groups of children. Although the two groups of children did not differ overall in their perceptions of pain intensity or affect, the ELBW children rated medical pain intensity significantly higher than psychosocial pain, unlike the FBW group. Also, duration of neonatal intensive care unit stay for the ELBW children was related to increased pain affect ratings in recreational and daily living settings. Despite altered response to pain in the early years reported by parents, on the whole at 8-10 years of age ELBW children judged pain in pictures similarly to their term peers. However, differences were evident, which suggests that studies are needed of biobehavioural reactivity to pain beyond infancy, as well as research into beliefs, attitudes, and perceptions about pain during the course of childhood in formerly ELBW children.

Are Perinatal Factors Predictive of Optimal School Age Outcome in the ELBW Infant? † 1241

The incidence of major developmental disabilities in the extremely low birth weight (ELBW) infant has remained stable despite dramatic improvement in survival. A subset of these children consistently overcome the odds, are neurologically intact, and demonstrate normal cognitive and academic skills. The purpose of this study is to identify perinatal predictors of optimal school age outcome in a sample of ELBW children. The study group consists of 257 surviving ELBW infants (<1001 grams) admitted to Vanderbilt University Hospital July 1982-July 1989. Information regarding presence of vision or hearing impairment, cerebral palsy, mental retardation, and school difficulty(need for special education or remedial resources after meeting school system eligibility criteria) at 7-9 yrs is available for 214 of 257 children (83%). The survivors were divided into three mutually exclusive subgroups: Group 1(n=66) is children with optimal outcome, no disability or school difficulty; Group 2 (n=71) is children with school difficulty, but no major difficulty; Group 3 (n=77) is children with any major disability. Data regardingobstetric risk (prenatal care, maternal smoking, presentation and mode of delivery, antenatal steroid administration, amnionitis, fetal heart rate tracing), neonatal course (birth weight, gestation, BPD, IVH, length of stay) and sociodemographics (race, gender, maternal age, education, marital status, social risk score) were analyzed by ANOVA and chi squares in relation to school age outcome for each of the three groups. The ELBW children with major developmental disability (Group 3) had significantly lower birth weight, shorter gestation, longer hospitalization, and more severe IVH than the remaining two thirds of the survivors in Groups 1 and 2 (p<0.05). However the children with optimal school age outcome (Group 1) and the children experiencing school difficulty (Group 2) did not differ significantly from each other on any of the obstetric, neonatal, or sociodemographic variables listed above, with the exception of gender. In our sample, the ELBW child spared major disability still has a 50% risk of experiencing school difficulty regardless of perinatal factors. If optimal outcome cannot be predicted by perinatal factors, then further research is important to identify mechanisms to reduce morbidity and promote optimal cognitive outcome in the rapidly growing population of ELBW survivors.

Neurosensory outcome and growth at three years in extremely low birthweight infants: follow-up results from the Swedish national prospective study.

A prospective national investigation comprising 633 extremely low birthweight (ELBW) infants born alive in the 2-y period 1990-1992 with a birthweight of < or = 1000 g and gestational age of > or = 23 completed weeks was conducted regarding neurosensory outcome and growth. Three-hundred and sixty-two (98%) surviving ELBW infants were assessed at a median age of 36 months, using a specially designed protocol. At follow-up, mean height, weight and head circumference in both boys and girls were significantly lower than the reference values. The incidence of cerebral palsy was 7% among all children and 14%, 10% and 3% in children born at 23-24, 25-26 and > or = 27 gestational weeks, respectively. At least one obvious handicap was present in 14%, 9% and 3% of these three groups of children, respectively. After adjustment for gestational age, a significantly increased risk of handicap was found in children with intraventricular haemorrhage grade > or = 3 and/or periventricular leucomalacia and in children with retinopathy of prematurity stage > or = 3. The results show that more than 90% of ELBW children born at > or = 25 completed gestational weeks were without neurosensory handicap at 36 months of corrected age. In infants born at 23-24 weeks of gestation, both survival and long-term outcome were less favourable.

Longitudinal study of neuropsychological outcome in blind extremely-low-birthweight children.

This study evaluated neurological and psychological development in 10 blind children over a 4-year period. Five of the children were born preterm with an extremely low birthweight (ELBW) and a diagnosis of retinopathy, whereas the other five were term. All children received their first neurological examination at a mean age of 10 months and then annual follow ups. In addition, the Bielefeld Developmental Test for Blind Infants and Preschoolers (BDTB) was administered every 6 months (from the ages of 18 to 48 months) to assess developmental outcome in different domains (e.g. cognition, language, gross motor abilities). Results showed a higher number of peri- and neonatal complications in blind ELBW children as well as a significantly higher number of neurological symptoms over the 4-year period. At the mean age of 4 years 10 months, blind ELBW children had a significantly lower body weight, body height, head circumference, and body-mass index compared with the term children. Findings on psychological development revealed that blind ELBW children also had significantly lower scores on all domains covered by the BDTB. Finally, the overall score on the BDTB correlated significantly with gestational age, birthweight, duration of mechanical respiration, and days spent in hospital after delivery.

Extremely Low-Birth-Weight Infants at Adolescence: Health Status and Quality of Life

<h3>To the Editor.</h3> —In their study of the self-perceived quality of life of extremely low-birth-weight (ELBW) adolescents, Dr Saigal and colleagues¹urge that "a great deal of caution be exercised" regarding possible clinical application of the high quality-of-life scores reported by the prematurely born teenagers. As the parent of a young adult with disabilities and as a medical writer familiar with the Canadian ELBW cohort, I would like to underscore this point. Caution is warranted because the 150 ELBW teenagers (compared with a control group of 124 term-born teenagers) have significantly underreported documented disabilities. At age 8 years, the ELBW and control children were evaluated by clinicians using a health status classification system.^2,3By clinical evaluation, 21% of the ELBW children had impaired mobility.^2,3However, only 10% of the ELBW teenagers, using the same health status classification system, reported mobility problems.¹At age 8 years, 1

School performance of ELBW children: a controlled study.

This paper examines the prevalence of learning difficulty in reading, spelling, mathematics and writing and the prevalence of attention deficit disorder (ADD) in extremely low-birthweight (ELBW) children at school compared to their peers. Parents of 87 eligible ELBW children completed an educational questionnaire and questionnaire for ADD. Teachers of the ELBW children completed a detailed educational and ADD questionnaire for the study child and two control children in the same class, matched for age and nearest in birth date to the study child. Parents reported that 4% of the ELBW children born between 1977 and 1986 were in a special education unit, 46% received remedial help and 21% repeated a grade. Teacher assessment of six aspects of reading and spelling and five aspects of mathematics and writing skills indicated that the ELBW children experienced marked problems in all areas compared to control children and were approximately 3 times more likely to be delayed by more than a year in all areas. Prevalence of ADD was not increased in the ELBW children compared to the control group, though males in both groups had a higher prevalence of symptoms. Early intervention and special education resources must be available for ELBW children attending school.

CHILDREN'S INTERPRETATIONS OF PAIN-PRODUCING SITUATIONS AT 8½ YEARS: ARE THEY AFFECTED BY PRIOR NOCIOCEPTIVE EXPERIENCES IN THE NEWBORN PERIOD? • 1582

Sequelae of early pain experience amongst extremely low birthweight (ELBW) children (≤ 1000g) have only been studied indirectly through parent report, which has suggested less pain responsivity at age 18 months, and more somatization at 4½ years amongst ELBW children compared with normal full birthweight (FBW) controls. The aim of the present study was to examine children's judgements about pain at age 8½ yrs., comparing two groups of children who had experienced different exposure to nociceptive procedures in the neonatal period: Group 1, ELBW(n=47; birthweight 808 (540 - 1000)grams; gestation 26.3 (23 - 31)weeks; duration of NICU stay 97 (28 - 240) days); Group 2, FBW (n=37; birthweight 3487 (2614 - 4706)grams; gestation 40 (38 - 42)weeks). Based on the premise that individuals' perceptions of pain in others reflect their own experiences, the children judged 24 pictures depicting pain in 4 types of settings: medical, recreational, daily living, and psychosocial (Pediatric Pain Inventory, Lollar DJ et al. J Ped Psychol 1981; 7:267-277). The subjects rated pain intensity using both a pain thermometer and a faces scale. The ratings on the two scales were moderately correlated for settings depicting physical pain (r = 0.53 to 0.68, p = 0.001 to 0.0001), but not psychosocial (r = 0.24, p = 0.15). Univariate repeated measures analysis of covariance was carried out, with IQ and mother's education as the covariates. Pain related to activities of daily living and recreation was significantly higher than psychosocial and medically related pain on both scales in both groups of children (p = 0.0001). Although the two groups of children did not differ overall in their perceptions of pain, the ELBW children rated medical pain significantly higher than psychosocial pain using the pain thermometer (p = 0.004). Also, duration of NICU stay for the ELBW children was slightly correlated with their ratings of pain in recreational and daily living settings, but only for the faces scale (p = 0.01 to 0.04). Despite marked differences in response to pain in the early years reported by parents, on the whole at 8½ years ELBW children appear to judge pain in others similarly to their term peers.

Predictive value of the Griffiths assessment in extremely low birthweight infants

To assess the relationship between the Griffiths Mental Development Scales at 1 and 3 years and the Stanford-Binet Intelligence Scale (S-B) and Beery Test of Visual-Motor Integration (VMI) at 5 years in extremely low birthweight (ELBW) children. Prospective study of 45 ELBW infants, without severe neurosensory impairment, cared for in a single Level III neonatal intensive care unit. At 5 years, 36 (80%) children were of average intelligence, 8 (18%) had borderline intelligence and one was mentally retarded. The Griffiths general quotient (GQ) at 1 year had a weak correlation with the 5 year IQ (corr. coeff. = 0.47), with only 17% of children with a GQ < -1 s.d. at 1 year receiving an IQ < -1 s.d. at 5 years. In contrast, the Griffiths GQ at 3 years correlated strongly with 5 year IQ (corr. coeff. = 0.78). Among those children with a 3 year GQ < -1 s.d., 67% had a 5 year IQ < -1 s.d. and all had a 5 year 1Q < 89. The 3 year hearing and speech subscale correlated strongly with the 5 year S-B verbal comprehension factor (corr. coeff. = 0.753) and the 3 year combined eye/hand co-ordination/performance quotient had a moderate correlation with the S-B non-verbal reasoning factor (corr. coeff. = 0.597) and with the Beery VMI (corr. coeff. = 0.49). The 3 year Griffiths GQ is a good predictor of 5 year S-B IQ in ELBW children and can be used to identify children who may benefit from intervention prior to school entry.

Neurosensory outcome at 5 years and extremely low birthweight. The Victorian Infant Collaborative Study Group.

To establish the stability of neurosensory outcome at 5 years of age compared with 2 years of age, and to determine whether the improving survival rate of extremely low birthweight (ELBW) (500-999 g) children has been accompanied by an increase in the number of severely impaired and disabled children in the community. A geographically determined cohort study was made of consecutive ELBW survivors born in the state of Victoria during 1985-7, and during 1979-80, inclusive. Rates of neurosensory impairments and disabilities at 2 and 5 or more years of age were measured. Of 212 children surviving to 5 years of age born during 1985-7, 211 (99.5%) had been assessed at 2 years of age, and 209 (98.6%) were assessed at 5 or more years of age. Of the 208 children seen at both 2 and 5 years, 32 children had deteriorated, 23 children had improved, and 153 were unchanged, compared with their 2 year assessment. The major reason for a change in classification was an alteration in psychological test results. Compared with ELBW children born in 1979-80, those born in 1985-7 had significant reductions in hearing and intellectual impairment. The rate of severe neurosensory disability in the 1985-7 cohort was 5.7% compared with 12.4% in children born in 1979-80. The age of 2 is too early to be sure of neurosensory outcome in ELBW infants. The additional survivors born in the mid 1980s, compared with the late 1970s, are free of severe neurosensory disability at 5 years of age, with no increase in the absolute number of ELBW children surviving with severe neurosensory disability.

Extremely low-birth-weight infants less than 901 g: development and behaviour after 4 years of life.

In a long-term, prospective, control study, 20 extremely low-birth-weight (ELBW) infants with birth weights between 500 and 900 g (mean 755 (SD 109) g) and gestational ages between 24 and 30 weeks (mean 26.2 (SD 1.8) weeks) were compared with 20 full-term infants at 4 years of age for growth, health, development and quality of life. Four of 20 (20%) ELBW children had major neurological disorders, which were all identified at the 1-year assessment. Seventeen (85%) ELBW children had cognitive development, assessed with the Griffiths mental development scale, within the normal range for age but lower than for full-term controls. The greatest deviations between ELBW and full-term children were found in locomotor and visual-motor integration functions. Eight ELBW children in all (40%), four with recurrent respiratory tract infections after neonatal mechanical ventilation and the four children with major neurological disorders had a higher rate of visits to physicians and hospital admissions. The behavioural symptom interview showed an increased rate of hyperactivity and difficulties in concentrating but not of general behavioural deviations in the ELBW group. Only by school age can all aspects of an extremely early birth be evaluated, but at 4 years of age, 85% of the ELBW children in our group had a good quality of life according to Scheffzek's categorizations.

Comparison of the health-related quality of life of extremely low birth weight children and a reference group of children at age eight years

To estimate and compare the health-related quality of life (HRQOL) of extremely low birth weight (ELBW) children and a reference group of children at age 8 years. The study utilized a utility equation from preference measures derived from a random sample of 194 general-population parents surveyed in 1987. This equation was applied to multiattribute health state descriptions of the study participants. Utilities can be used to estimate a single cardinal value between 0.0 and 1.0 (0 = dead; 1 = perfect health) to reflect the global HRQOL for that individual. Geographically defined region in central-west Ontario, Canada. One hundred fifty-six ELBW survivors born between 1977 and 1982, and 145 reference children from the general population, matched for age, sex, and socioeconomic status to the index cases. Mean HRQOL scores were lower for ELBW (0.82, SD 0.21) than for reference group (0.95, SD 0.07; p < 0.0001). The ELBW group had greater variability in HRQOL scores (p < 0.001), and the distribution was such that 50% of ELBW children but only 10% of the reference group had scores < 0.88. Only 14% of ELBW children were assigned HRQOL scores of 1.0, compared with 50% of reference subjects (p < 0.0001). These results demonstrate that from the perspective of the general population, the overall long-term burden experienced by ELBW children is greater than that for reference children. The methods used to assess HRQOL have wide applicability for evaluation of different treatment programs.

Pain sensitivity and temperament in extremely low-birth-weight premature toddlers and preterm and full-term controls

High-technology medical care of extremely low-birth-weight (ELBW) infants (< 1001 g) involves repeated medical interventions which are potentially painful and may later affect reaction to pain. At 18 months corrected age (CCA), we examined parent ratings of pain sensitivity and how pain sensitivity ratings related to child temperament and parenting style in 2 groups of ELBW children (49 with a birth weight of 480–800 g and 75 with a birth weight of 801–1000 g) and 2 control groups (42 heavier preterm (1500–2499 g) and 29 full-birth-weight (FBW) children (> 2500 g)). Both groups of ELBW toddlers were rated by parents as significantly lower in pain sensitivity compared with both control groups. The relationships between child temperament and pain sensitivity rating varied systematically across the groups. Temperament was strongly related to rated pain sensitivity in the FBW group, moderately related in the heavier preterm and ELBW 801–1000 g groups, and not related in the lowest birth-weight group (< 801 g). Parental style did not mediate ratings of pain sensitivity. The results suggest that parents perceive differences in pain behavior of ELBW toddlers compared with heavier preterm and FBW toddlers, especially for those less than 801 g. Longitudinal research into the development of pain behavior for infants who experience lengthy hospitalization is warranted.

7 Outcome of infants born preterm, with special emphasis on extremely low birthweight infants

The outcome of extremely low birthweight (ELBW) infants has been reviewed from published articles and up-to-date data from Japan. The mortality rate of these infants declined significantly from over 90% to below 50% after the introduction of intensive care in the 1970s, but the incidence of major neurological sequelae remained steady at around 20%. Similarly, the incidence of major neurological sequelae did not increase along with the decrement of birthweight, although the mortality rate increased significantly. Long-term follow-up of ELBW children until school age has revealed poor school performance in spite of the absence of major neurological sequelae and the attainment of average intelligence quotient scores. Physical growth is retarded initially but generally catches up by the age of 8-9 years. In Japan, the neonatal mortality rate of ELBW infants declined from 56% in 1981 to 25% in 1989 with an increased birth rate of ELBW infants. In ELBW infants cared for at Tokyo Women's Medical College during 1984-90, the survival rate was 112 out of 134 (84%) and the incidence of major neurological sequelae was 15 out of 87 (17%) at 1-8 years old. The viability limit of ELBW infants has been discussed based on recent data. As a result of the rapid progress of medical care of ELBW infants, their viability limit as defined in the Eugenic Protection Law in Japan was amended from 24 completed weeks of gestation to 22 completed weeks in 1991.

Extremely low birthweight infants at 3 years: A developmental profile

This study documents the neurodevelopmental outcome at 3 years of 52 of 55 extremely low birthweight (ELBW) survivors (survival rate 49%) born in a tertiary maternity centre from July 1985 through December 1988, and examines more closely the developmental profile of the neurologically normal survivors. At 3 years, 6 (12%) children had severe neurodevelopmental impairment (severe cerebral palsy, blindness, deafness or a General Quotient (GQ) < 70 on the Griffiths Scales), 11 (21%) had mild to moderate impairment and 35 (67%) had no neurosensory impairment and normal development (GQ > or = 85). Significant risk factors for severe impairment were stage 3 or 4 retinopathy of prematurity (odds ratio [OR] 21.5), treatment with postnatal steroids (OR 21), grade III or IV intraventricular haemorrhage (OR 11) and supplemental oxygen at 'term' (OR 6.4). The developmental profile of the 35 neurologically normal children revealed a significant weakness in eye and hand coordination skills and a relative strength in hearing and speech skills. Early recognition of this developmental profile may allow implementation of more appropriate preschool programmes for ELBW children.

Psychopathology and adaptive functioning among extremely low birthweight children at eight years of age

AbstractThe objective of this study was to explore the relationship among extremely low birthweight (ELBW), psychopathology, and impairments in adaptive functioning in a regional cohort of 7–8-year-old children with a birthweight of 501–1,000 g compared to a sample of full-term controls. One-hundred twenty-nine of 143 (90%) ELBW survivors and 145 controls, born between 1977 and 1981, agreed to participate in the study. The children were assessed at a mean, unadjusted age of 7.8 years. Results showed that parents of ELBW children were more likely than parents of controls to report specifically problems of attention-deficit hyperactivity disorder (ADHD). There were few differences between the groups in terms of impairments in adaptive functioning. Further analyses showed that the relationship between ELBW and ADHD could not be explained by confounding psychosocial risk factors, nor were ELBW children from disadvantaged environments more likely to have ADHD problems than ELBW children from nondisadvantaged environments. The relationships between ELBW and ADHD problems appeared to be associated with the lower IQ of the ELBW subjects.

Can Learning Disabilities in Children Who Were Extremely Low Birth Weight Be Identified at School Entry?

This prospective study was designed to test the hypothesis that a significant proportion of extremely low birth weight (ELBW) children identified as "at risk" for school problems at age 5 years by the Florida Kindergarten Screening Battery (FKSB) will present with specific learning disability (LD) when retested at age 8 years. A regional cohort of 81 of 84 ELBW survivors born between 1980 and 1982 were reassessed at age 8 years by Wechsler Intelligence Scale for Children-Revised (WISC-R), Wide Range Achievement Test-Revised (WRAT-R), and tests of motor function. The association of FKSB risk status and WRAT-R reading subtest for predicting general reading disability in the overall sample at age 8 years resulted in a sensitivity of 0.68, specificity of 0.48, and a likelihood ratio of 1.3. Of the 43 "normal" children at age 5 years with no neurosensory impairments and IQ > or = 84 (McCarthy GCI), 49% were considered to be at "mild" to "high" risk for future LD. The prevalence of specific LD (reading disorder) at age 8 years in children with normal IQ (WISC-R > or = 85) was 28%. The positive predictive value of the 5-year FKSB for identifying children with specific LD at age 8 years was 0.20 (sensitivity 0.33, specificity 0.48). We conclude the FKSB is not an efficient tool for predicting either general or specific LD in ELBW children.