VLBW Children Research Articles

Cortical morphometry and IQ in VLBW children without cerebral palsy born in 2003-2007.

Children born prematurely with very low birth weight (VLBW: bw ≤ 1500 g) have an increased risk of preterm perinatal brain injury, which may subsequently alter the maturation of the brain, including the cerebral cortex. The aim of study was to assess cortical thickness and surface area in VLBW children compared with term-born controls, and to investigate possible relationships between cortical morphology and Full IQ. In this cross-sectional study, 37 VLBW and 104 term children born between the years 2003–2007 were assessed cognitively at 5–10 years of age, using age appropriate Wechsler tests. The FreeSurfer software was used to obtain estimates of cortical thickness and surface area based on T1-weighted MRI images at 1.5 Tesla. The VLBW children had smaller cortical surface area bilaterally in the frontal, temporal, and parietal lobes. A thicker cortex in the frontal and occipital regions and a thinner cortex in posterior parietal areas were observed in the VLBW group. There were significant differences in Full IQ between groups (VLBW M = 98, SD = 9.71; controls M = 108, SD = 13.57; p < 0.001). There was a positive relationship between IQ and surface area in both groups, albeit significant only in the larger control group. In the VLBW group, reduced IQ was associated with frontal cortical thickening and temporo-parietal thinning.We conclude that cortical deviations are evident in childhood even in VLBW children born in 2003–2007 who have received state of the art medical treatment in the perinatal period and who did not present with focal brain injuries on neonatal ultrasonography. The cortical deviations were associated with reduced cognitive functioning.

PO-0642 Neurodevelopmental Outcomes Of Vlbw Children At 6–8 Years Of Age

<h3>Background</h3> There is growing awareness that the majority of nondisabled survivors encounter more “subtle” problems such as academic under achievement, behavioural problems, and deficits in executive functions. <h3>Objective</h3> To compare gross motor function,cognitive function, academic competence and behavioural problems at school age between VLBW children and controls. <h3>Methods</h3> We enrolled children aged 6-to 8-year-old, who were born with BW ≤1,500 g and have been followed-up at our long-term, follow-up clinic. They were tested for cognitive function and academic achievement using Wechsler Intelligence Scale for Children-III(WISC-III) and Wide Range Achievement Test (WRAT). Child Behaviour Checklist for emotional/behavioural assessment was completed by the care givers. Gross motor function was assessed using Gross Motor Function Classification System (GMFCS). <h3>Results</h3> Thirty VLBW children were assessed at mean age of 7.5 years; 30 children born at term (matched for age, sex, and family income) served as controls. WISC-III scores were comparable between the two groups (99.8 ± 2.4 and 105.8 ± 1.7; p = 0.072 in VLBW and control group, respectively) as well as the WRAT scores. GMFCS-mild dysfunction was found only in 2 children (6.7%) of VLBWgroup. In contrast, VLBW children had more behavioural/emotional problems, especially in attention deficit/hyperactive (26.7% in VLBW group vs.3.3% in controls, p = 0.026). <h3>Conclusions</h3> In our cohort study, VLBW children at school age are at higher risk for behavioural/emotional problems, especially in attention deficit compared with children born at term. However, no differences in cognitive, academic, and gross motor function were found.

PO-0415 Corpus Callosum Size As A Predictor Of Visual Problems Among 4-year-old Very Low Birth Weight Children

Background Correlation between corpus callosum (CC) size and motor performance in prematurely born children has been described. It is speculated that the organisation of CC can be associated with visual acuity in preterm children. Aim To assess the relation between CC size and vision impairment, results of Frostig test of visual perception and Visual evoked potentials (VEP) in a group of VLBW children. Methods 40 children born with a mean birthweight of 1023g (SD 230g) were evaluated at the mean age of 4 years (range 3.7–4.3). The children were examined for clinical signs of vision impairment and were subjected to Frostig test. VEP was recorded after checkerboard pattern and flash stimulation. Morphological brain changes and CC size were evaluated using standard MRI sequences. The MRI evaluators were not informed about the results of visual examinations. Results Impaired visual acuity was detected in 9/12 cases with abnormal CC (75%) and in 10% of children with normal CC (p Conclusion A strong correlation between vision impairment and CC size was observed. This suggests that CC plays important function in integration of visual perception. Study supported by National Science Centre, Poland: grant number: 2011/03/B/NZ5/05678.

Effects of maternal sensitivity on low birth weight children's academic achievement: a test of differential susceptibility versus diathesis stress.

Differential Susceptibility Theory (DST) postulates that some children are more affected - for better and for worse - by developmental experiences, including parenting, than others. Low birth weight (LBW, 1,500-2,499g) may not only be a predictor for neurodevelopmental impairment but also a marker for prenatally programmed susceptibility. The aim was to test if effects of sensitive parenting on LBW and very LBW (VLBW, <1,500g) versus normal birth weight (NBW, ≥2,500g) children's academic achievement are best explained by a differential susceptibility versus diathesis-stress model of person-X-environment interaction. Nine hundred and twenty-two children ranging from 600g to 5,140g birth weight were studied as part of a prospective, geographically defined, longitudinal investigation of neonatal at-risk children in South Germany (Bavarian Longitudinal Study). Sensitive parenting during a structured mother-child interaction task was observed and rated at age 6years. Academic achievement was assessed with standardized mathematic, reading, and spelling/writing tests at age 8years. Maternal sensitivity positively predicted the academic achievement of both LBW (n=283) and VLBW (n=202) children. Confirmatory-comparative and model-fitting analysis (testing LBW vs. NBW and VLBW vs. NBW) indicated that LBW and VLBW children were more susceptible than NBW to the adverse effects of low-sensitive, but not beneficial effects of high-sensitive parenting. Findings proved more consistent with the diathesis stress than differential-susceptibility model of person-X-environment interaction: LBW and VLBW children's exposure to positive parenting predicted catch-up to their NBW peers, whereas exposure to negative parenting predicted much poorer functioning.

Height, Muscle, Fat and Bone Response to Growth Hormone in Short Children with Very Low Birth Weight Born Appropriate for Gestational Age and Small for Gestational Age

Background/Aims: Growth hormone (GH) treatment is approved for short children born SGA but not for AGA. Our aim was to study the effect of GH in short VLBW SGA and AGA children. Methods: The study group comprised 44 prepubertal short children with a birth weight <1,500 g: 27 AGA (12 females) and 17 SGA (6 females). Mean values at GH start were (AGA, SGA): age 6.94, 7.14 years, height standard deviation score (SDS) -3.33, -3.33, and GH dose (mean ± SD) 54 ± 12, 51 ± 11 µg/kg/day. Arm and calf cross-sectional muscle area using peripheral quantitative computer tomography, body composition data using dual-energy X-ray absorptiometry and body impedance assessment, maximal isometric grip force and skin fold thickness, IGF-1 and IGFBP-3 were measured at the start and after 12 months of GH. Results: At GH start, both groups had similar characteristics with low height, weight, height velocity, muscle mass, bone thickness and content. The first year of GH treatment led to changes in muscle area SDS (AGA, SGA) -2.23 to -0.73 (p = 0.0010), -3.18 to -1.17 (p = 0.060) (AGA vs. SGA p = 0.61), fat area SDS -1.06 to -1.83 (p = 0.054), -0.62 to -1.75 (p = 0.12) (AGA vs. SGA p = 0.65) and height velocity SDS -0.0015 to 4.2 (p < 0.0001), -0.18 to 3.3 (p < 0.0001) (AGA vs. SGA p = 0.36). Conclusions: Growth, muscle and fat mass are similarly impaired in short prepubertal AGA and SGA VLBW children. The children born AGA show a similar or better response to GH compared to those born SGA. These results reveal the arbitrary nature of using the criterion ‘SGA' for eligibility to GH treatment in children born with a birth weight <1,500 g.

Early relations between language development and the quality of mother–child interaction in very-low-birth-weight children

BackgroundIt is not clearly understood how the quality of early mother–child interaction influences language development in very-low-birth-weight children (VLBW). AimsWe aim to analyze associations between early language and the quality of mother–child interaction, and, the predictive value of the features of early mother–child interaction on language development at 24months of corrected age in VLBW children. Study designA longitudinal prospective follow-up study design was used. MethodsThe participants were 28 VLBW children and 34 full-term controls. Language development was measured using different methods at 6, 12 and at 24months of age. The quality of mother–child interaction was assessed using PC-ERA method at 6 and at 12months of age. ResultsAssociations between the features of early interaction and language development were different in the groups of VLBW and full-term children. There were no significant correlations between the features of mother–child interaction and language skills when measured at the same age in the VLBW group. Significant longitudinal correlations were detected in the VLBW group especially if the quality of early interactions was measured at six months and language skills at 2years of age. However, when the predictive value of the features of early interactions for later poor language performance was analyzed separately, the features of early interaction predicted language skills in the VLBW group only weakly. ConclusionsThe biological factors may influence on the language development more in the VLBW children than in the full-term children. The results also underline the role of maternal and dyadic factors in early interactions.

Screening for autism in preterm children with extremely low and very low birth weight

BackgroundStudies of children with very low birth weight (VLBW, 1,000–1,500 g) and extremely low birth weight (ELBW, less than 1,000 g) indicate that this population seems to be at increased risk of autism spectrum disorder (ASD).MethodsParents of 101 VLBW and ELBW children (age 2 years, corrected for prematurity) agreed to participate in the study and signed informed consents; however, parents of only 75 children (44 boys, 31 girls) completed the screening questionnaires. The screening battery included the Modified Checklist for Autism in Toddlers (M-CHAT), Communication and Symbolic Behavior Scales Developmental Profile Infant-Toddler Checklist (CSBS-DP-ITC), and the Infant/Toddler Sensory Profile (ITSP). Children with disabilities were excluded. All children who screened positive on any of the screening tools were subsequently invited for a detailed assessment.ResultsThirty-two children (42.7%) screened positive on at least one of the screening questionnaires. The screening tool with the most positive results was the CSBS-DP-ITC (26 positive screens), followed by the M-CHAT (19 positive screens) and the ITSP (11 positive screens). Of the 32 children who tested positive, 19 participated in the detailed follow-up assessment. A diagnosis of ASD was confirmed in eight of the 19 children. ASD prevalence, calculated from those 19 children and those with negative screening results (43 children), yielded a prevalence of 12.9% in the sample. The difference in frequency of positive screens between the tests was significant (P=0.011). In pair comparisons, ITSP was found to be significantly less positive than CSBS-DP-ITC (P=0.032). No significant differences were found between the M-CHAT and CSBS-DP-ITC or between the M-CHAT and ITSP.ConclusionThe results strongly support the hypothesis of an increased prevalence of autism in children with a birth weight less than 1,500 g.

Associations between parental psychological well-being and socio-emotional development in 5-year-old preterm children

BackgroundPreterm children are at risk for developing behavioral and emotional problems, as well as being less socially competent. Premature birth causes chronic distress in the parents. AimsThe aim of the paper is to discover whether parental psychological well-being is associated with the social, behavioral, and functional development of very low birth weight (VLBW, ≤1500g) children at 5years of age. Study designA longitudinal prospective cohort study. SubjectsA cohort of 201 VLBW infants (≤1500g, <37weeks of gestation) born during 2001–2006 in Turku University Hospital, Finland was studied. Outcome measuresAt 4-year chronological age of their child, parents independently completed validated questionnaires (Beck Depression Inventory, Parenting Stress Index and Sense of Coherence Scale). At 5years, parents and day-care providers evaluated the development of the child by completing the Five to Fifteen questionnaire. ResultsThe parents of VLBW children reported significantly more problems in child development compared to the Finnish normative data. Depressive symptoms and weaker sense of coherence in mothers, but not in fathers, were associated with more problems in child development. Parenting stress, for both mothers and fathers, was associated with developmental problems in their child at 5years of age. ConclusionsMaternal depressive symptoms and parenting stress of both parents may be risk factors for the social, behavioral, and functional development of 5-year-old preterm children. On the other hand, stronger maternal sense of coherence may be a protective factor.

Medical, cognitive and academic outcomes of very low birth weight infants at age 10–14 years in Ireland

Low birth weight (LBW) is a leading cause of infant mortality and morbidity, and a specific risk for the development of neuro-developmental and academic problems. To examine the medical, cognitive and academic outcomes of VLBW (<1,500 g) children, born in one maternity hospital in Dublin between 1995 and 1997. The study employed a prospective/cohort design, with semi-structured, and standardised measures, along with the completion of a study-specific questionnaire. Ratings were obtained from parents and teachers. Of the 127 surviving VLBW cohort, 64 (50 %) consented to assessment at a mean age of 11.6 years (SD 1.0) along with a matched-weight and gender control sample of 51. VLBW children had an increased risk of chronic medical problems and neuro-sensory deficits, but without any increased use in services. Similarly, they had lower IQ (mean 89.7 compared to NBW 101.3, p < 0.001) and more were identified by teachers to have special education needs (33 % VLBW vs. 7 % NBW, p < 0.005). With regard to academic attainments, birth weight had a significant [t(98) = -4.54, p < 0.001] and robust effect (η(2) = 0.17) on mathematical attainment scores. Those with lower SES fared least well off. Although significant advances have been made in reducing infant mortality, there is a recognised increased risk of subsequent disability especially with decreasing gestational age, and when coupled with low SES. Having facilitated the survival of vulnerable infants, services must be available for the necessary on-going medical and educational support and treatment that they require throughout adolescent years.

Usefulness of ICF-CY to define functioning and disability in very low birth weight children: A retrospective study

BackgroundPreterm birth is associated with variable degrees of brain injury, adverse neurodevelopmental outcomes and continuing special health care needs. Study and aimsThis observational, retrospective and cross-sectional study aims to describe the functional features of VLBW infants using the ICF-CY classification and to identify the association between gender, twinship, birth weight, gestational age, adjusted age and functioning as defined by the ICF biopsychosocial model. Sample56 VLBW infants (corrected age of 12–24months) were consecutively enrolled. InstrumentsThree assessment tools were used: a neuro-functional assessment (NFA); the Griffiths Mental Development Scales-Revised: Birth to 2years (Griffiths 0–2) to evaluate psychomotor development and the ICF-CY questionnaire for ages 0–3. ResultsA two-step cluster component analysis with the Bayesian information criterion was conducted based on NFA and Griffiths 0–2 scores and four groups of infant's functioning (very low, low, intermediate, high) emerged. Study findings demonstrate that the traditional assessment tools tend to poorly evaluate the interaction between the person's functioning and environment factors (EF), even thought EF results to be relevant for VLBW infants. The higher number of symptoms, more difficulties in activities and participations and the higher number of environmental facilitators maximize the difference between infants with very low and those with intermediate or higher functioning. The distribution of gender or the presence of siblings is not significantly associated to any group. ConclusionThis study shows that a more complete evaluation of functioning of VLBW children, based on the biopsychosocial approach, is needed and can be successfully implemented in the follow-up routine through ICF-CY questionnaire.

Bindungsqualität bei sehr kleinen Frühgeborenen (&lt; 1500 g) und ihren Müttern

A long hospital stay, along with the worries about the survival and the possible disabilities the child might suffer from, mark the start into life of very low birth weight premature infants (VLBW). The goal of this trial was to study the stability of the attachment representations of very low birthweight infants (birthweight < 1500 g) and the accordance of the attachment representations of the children and their primary care givers. In continuation of the Kölner Frühgeborenen Studie, we measured the attachment patterns of 40 VLBW children at the age of seven and their mothers. For the children we used the Geschichtenergänzungsverfahrens zur Bindung (GEV-B) and for the mothers the Adult Attachment Projective (AAP) to determine the attachment representation. The attachment representations first corresponded to a normal distribution pattern and shifted over time to a more insecure attachment. We could not determine a significant link between the attachment patterns of the child and their mother.

Perinatal and neonatal predictors of developmental coordination disorder in very low birthweight children

ObjectiveTo identify perinatal and neonatal risk factors associated with developmental coordination disorder (DCD) in very low birthweight children (VLBW: <1250 g).DesignRetrospective design with prospectively collected cohort.SettingNeonatal Follow-Up Program, Vancouver, Canada.Patients157...

Eight-Year Developmental Follow-up in Children with Birthweights 1,251–1,500g in KK Women's and Children's Hospital

Background:Children of very low birth weight (VLBW, birth weight &lt;1,500g) are at risk of developmental disability and learning difficulties. Regular follow-up to a school-going age allows timely diagnosis and intervention.Methods:The duration, developmental assessment and service utilisation of 41 VLBW children with birth weights between 1,251–1,500g born in 2001 were retrospectively analysed.Results:The median follow-up duration was 5 years 11 months. 56% were followed-up till preschool entry. Gross motor, fine motor and language domains were assessed in more than 95% of children. Information on behavioural and learning problems was only sought for in approximately 50% of children.Conclusions:A significant proportion of these high-risk children were either not followed-up long enough or were not adequately assessed for learning and behavioural problems, thus justifying the development of a new standardised follow-up program for larger VLBW children.

324 A Neurobehavioral Intervention and Assessment Program in very Low Birth Weight Infants; Outcome at 5 Years of Corrected Age

BackgroundWe carried out a RCT to evaluate the effect of the Infant Behavioral Assessment and Intervention Program (IBAIP) in 176 VLBW infants. This post discharge intervention program was given until...

1229 Computerized Working Memory Training is Effective in Preterm Born Children at Preschool Age

Background and AimsWorking memory (WM) is defined as the skill to retain and manipulate information “on-line” over short periods of time. Deficits in WM are frequently reported in preterm children...

Parental Psychological Well-Being and Behavioral Outcome of Very Low Birth Weight Infants at 3 Years

The purpose was to explore whether poor parental psychological well-being is associated with behavioral problems of very low birth weight (VLBW, ≤1500 g) infants at 3 years of age. In this prospective cohort study, 189 VLBW preterm infants born between January 2001 and December 2006 at the Turku University Hospital, Finland, were followed. Validated questionnaires (Beck Depression Inventory, Parenting Stress Index, and Sense of Coherence Scale) were mailed to the parents when their children were 2 years corrected age. A total of 140 parents evaluated the behavior of the child at 3 years by filling out the Child Behavior Checklist. There were significant associations between most of the measures of parental symptoms of depression, parenting stress, and sense of coherence and the behavioral outcome of the VLBW infants. The concomitant symptoms of both parents were associated with more problematic child behavior. Parents report more behavioral and emotional problems in VLBW children at age 3 if they themselves have had symptoms of depression, parenting stress, or weak sense of coherence 1 year earlier. The new finding of this study was to show the significance of the father's psychological well-being on the behavioral development of a preterm child.

Stability of Cognitive Outcome From 2 to 5 Years of Age in Very Low Birth Weight Children

This study assessed the stability of cognitive outcomes of premature, very low birth weight (VLBW; ≤1500 g) children. A regional cohort of 120 VLBW children born between 2001 and 2004 was followed up by using the Bayley Scales of Infant Development, Second Edition, at 2 years of corrected age and the Wechsler Preschool and Primary Scale of Intelligence-Revised at the age of 5 years. The Mental Development Index (MDI) and the full-scale IQ (FSIQ) were measured, respectively. A total of 168 randomly selected healthy term control children born in the same hospital were assessed for MDI and FSIQ. In the VLBW group, mean ± SD MDI was 101.2 ± 16.3 (range: 50-128), mean FSIQ was 99.3 ± 17.7 (range: 39-132), and the correlation between MDI and FSIQ was 0.563 (P < .0001). In the term group, mean MDI was 109.8 ± 11.7 (range: 54-128), mean FSIQ was 111.7 ± 14.5 (range: 73-150), and the correlation between MDI and FSIQ was 0.400 (P < .0001). Overall, 83% of those VLBW children who had significant delay (-2 SD or less) according to MDI had it also in FSIQ. Similarly, 87% of those children who were in the average range in MDI were within the average range in FSIQ as well. Good stability of cognitive development over time was found in VLBW children and in term children between the ages of 2 and 5 years. This conclusion stresses the value and clinical significance of early assessment at 2 years of corrected age. However, we also emphasize the importance of a long-term follow-up covering a detailed neuropsychological profile of these at-risk children.

Effects of neonatal enteral glutamine supplementation on cognitive, motor and behavioural outcomes in very preterm and/or very low birth weight children at school age

In very preterm (<32 weeks of gestation) and/or very low birth weight (VLBW, <1500g birth weight) children, serious neonatal infections are among the main causes of poor developmental outcomes later in childhood. The amino acid glutamine has been shown to reduce the incidence of serious neonatal infections in very preterm and/or VLBW children, while developmental effects beyond 24 months are unknown. We determined the cognitive, motor and behavioural outcomes at school age of a cohort of sixty-four very preterm and/or VLBW children (aged 7·5 (sd 0·4) years) who participated in a randomised placebo-controlled trial using enteral glutamine between day 3 and day 30 of life. Cognitive and motor outcomes were studied using the Wechsler Intelligence Scale for Children-III, the Movement Assessment Battery for Children (MABC), the Attention Network Test and a visual working memory task. Behavioural outcomes were evaluated using parent- and teacher-rated questionnaires. Intelligence quotient, processing speed, attentional functioning, working memory and parent- and teacher-rated behavioural outcomes were not different between children treated with glutamine or placebo; only visuomotor abilities as measured by the Ball Skills scale of the MABC (P=0·002; d=0·67) were poorer in the glutamine group. This effect persisted after taking into account the beneficial effects of lower serious neonatal infections rates in children treated with glutamine (P=0·005). In conclusion, glutamine supplementation between day 3 and day 30 of life had neither beneficial nor detrimental effects on long-term cognitive, motor and behavioural outcomes of very preterm and/or VLBW children at school age, although visuomotor abilities were poorer in children that received glutamine.

Long term follow-up of health-related quality of life in young adults born very preterm or with a very low birth weight.

BackgroundThe purpose was, first, to evaluate changes in health-related quality of life (HRQL) in a cohort of very low birth weight (VLBW; <1500 g.) or very preterm (< 32 weeks of gestation) children between ages 14 and 19, and second, to identify correlates of HRQL at age 19.MethodsHRQL was assessed using the Health Utilities Index Mark 3 (HUI3). In order to explore correlates of HRQL, we performed a hierarchical regression analysis.ResultsSurviving VLBW children (n = 959) from a 1983 Dutch nation-wide cohort were eligible; 630 participated both at age 14 and 19; 54 at age 19 only. The mean HRQL score decreased from 0.87 to 0.86. The HRQL of 45% was stable, 25% were better and 30% were worse. A regression model showed internalizing problems were related most strongly to HRQL.ConclusionsIn the transition from adolescence to young adulthood, HRQL in Dutch VLBW children was stable at the group level but varied at the individual level. HRQL was negatively associated with internalizing problems and also with physical handicaps. Long-term follow-up studies on the impact of VLBW on HRQL are all the more called for, given the growing number of vulnerable infants surviving the neonatal period.

Effect Of Low Birth Weight And Very Low Birth Weight On Primary Dentition In The Indian Population

Prematurity and low birth weight [LBW] children account for approximately 7-17% of all live births. They are prone to several medical complications during the antenatal and postnatal period which may adversely affect the development of oral tissues. The purpose of the study was to study the prevalence of enamel defects in prematurely born LBW and very low birth weight children [VLBW] in Indian population. The study was made on children between 9 months to 35 months of age. This study shows that the prevalence of enamel defects increases with decreasing birth weight. The prevalence in VLBW children [weight 2.5 kg] was 74.1%, 26.5% and 18% respectively. In very low birth weight children left sided defect occurred twice as frequently as right sided defects; probably the result of trauma from left sided laryngoscopy.