Years Of Age In Infants Research Articles

Follow-up Outcomes at 1 and 2 Years of Infants Born Less Than 32 Weeks After Newborn Individualized Developmental Care and Assessment Program

This was a randomized, controlled trial to investigate the effect of Newborn Individualized Developmental Care and Assessment Program on growth, cognitive, psychomotor, and neuromotor development at 1 and 2 years in infants born at <32 weeks' gestational age. Infants were randomly assigned within 48 hours of birth to the newborn individualized developmental care and assessment program group (intervention) or basic developmental care group (control group [ie, incubator covers and nests]). At 1 and 2 years' corrected age, growth was measured and standardized neurologic examinations were administered. Mental and psychomotor development was assessed by using the Dutch version of the Bayley Scales of Infant Development II. Neurologic outcome, Psychomotor Developmental Index, and Mental Developmental Index scores were combined a total outcome measure. One hundred sixty-eight infants were recruited (intervention: 84; control: 84). Four infants (newborn intervention: 3; control: 1) were excluded because they were admitted less than or died within the first 5 days, leaving a total of 164 infants who met inclusion criteria. In-hospital mortality was 8 of 81 in the intervention group and 3 of 83 in the control group. At 1 year of age 148 children (intervention: 70; control: 78) and at 2 years of age 146 children (intervention: 68; control: 78) were assessed. There was no significant difference in growth at 1 and 2 years of age. There was no significant difference found in neurologic outcomes or mental and psychomotor development at 1 and 2 years of age. When neurologic outcome, Mental Developmental Index and Psychomotor Developmental Index scores were combined, there still remained no significant difference. Newborn individualized developmental care and assessment program developmental care showed no effect on growth or neurologic, mental, or psychomotor development at 1 and 2 years of age in infants born at <32 weeks. Duration of the intervention was not associated with neurologic and developmental outcome.

No change in developmental outcome with incubator covers and nesting for very preterm infants in a randomised controlled trial

Objective:To investigate in a randomised controlled trial the effect of basic elements of developmental care (incubator covers and positioning aids) on growth and neurodevelopment in infants born at < 32...

Upper limb movements and outcome in intrauterine-growth-retarded infants at 2 years

This study aims to examine the usefulness of spontaneous upper limb movements (ULM) as an early marker for predicting neurodevelopmental outcome in infants with intrauterine-growth retardation (IUGR). The assessment of general movements (GMs) during the first 20 weeks is an accepted method for early detection of brain dysfunction. During this period, spontaneous upper limb movements were examined in 32 infants with IUGR and 32 appropriate-for-gestational-age-matched controls. ULM (arms, forearms and hands) were scored as optimal or suboptimal by sequential videotape recordings in the writhing (term-2 weeks: score 0–5); early fidgety (9–11 weeks: score 0–6); and late fidgety (14–16 weeks: score 0–6) periods, and correlated with neurodevelopmental score at 2 years of age. The mean ULM score was lower in the IUGR infants than the controls ( p < 0.05) and in the IUGR group was lower in the infants with abnormal outcome ( p < 0.05). Significant correlations were found between ULM and 2-year neurodevelopmental scores in the IUGR group. The ULM during late-fidgety period was most predictive for 2-year neurodevelopmental score. No difference was found in the mean ULM score between the pre-term and term IUGR infants. We conclude that ULM score can serve as an early predictor for neurodevelopmental outcome at 2 years of age in infants with IUGR.

Longitudinal follow-up of height up to five years of age in infants born preterm small for gestational age; comparison to full-term small for gestational age infants

Objective This aims to conduct a comparative study of the height catch-up rate in preterm small for gestational age (SGA) infants during early childhood by gestational age and identify the factors affecting short stature in comparison to full-term SGA infants. Methods 449 SGA infants (214 full-term infants, 73 infants with gestation of less than 32 weeks, and 162 infants with gestation of more than 32 weeks but less than 37 weeks) from 25 institutions in Japan were assessed for catch-up (≧ − 2SD) rate in growth by measuring for length/height at 1 year, 3 years and 5 years of age and the risk factors for no catch-up (< − 2SD) at 5 years. Results The overall length/height catch-up rate was 68% at 1 year, 89% at 3 years and 88% at 5 years. The catch-up rate at 3 and 5 years of age in the group with gestation of less than 32 weeks had a rate of 74%, which was significantly less than the other two groups (approximately 90%). A significant factor associated with short stature at 5 years in the group with gestation of less than 32 weeks was the lower length SD score at time of birth, and for preterm infants born more than 32 weeks of gestation and full-term infants, significant factors were the lower maternal height and head circumference at birth. Conclusion SGA infants born less than 32 weeks of gestation had a higher risk of no catch-up and different factors affecting catch-up compared to preterm SGA infants of gestation more than 32 weeks and full-term SGA infants.

Brain Injury in Congenital Heart Disease

Mortality rates for virtually all forms of congenital heart disease have declined with dramatic advances in medical, transcatheter, and surgical therapies. 1 As the population of congenital heart disease survivors has burgeoned, however, their long-term functional morbidities have become the focus of increasing concern. Among the foremost morbidities are adverse neurodevelopmental outcomes, with their profound personal and societal costs. 2 Article p 280 Neurological and developmental outcomes of congenital heart patients are influenced by many factors, both innate and acquired, with cumulative effects. Genetic syndromes such as trisomy 21 or 22q11 microdeletion3–5 may affect both the heart and the brain. Cerebral dysgenesis is reported to occur in 10% to 29% of children with congenital heart disease in autopsy series, with the incidence varying by lesion 6–8 ; findings may range from microdysgenesis to gross abnormalities such as agenesis of the corpus callosum, incomplete operculization, and microcephaly. During fetal life, congenital heart lesions may be associated with changes in cerebrovascular blood flow distribution and resistance. For example, fetuses with hypoplastic left heart syndrome, whose cerebral perfusion is supplied retrograde through the ductus arteriosus, have lower cerebrovascular resistance than normal. 9 Postnatal neurodevelopmental risk factors may derive from the sequelae of congenital heart disease itself—eg, chronic severe hypoxemia, failure to thrive, arrhythmias with cardiac arrest or hypotension—or from the procedures used for cardiac correction or palliation.10 Neuropathological studies have revealed both focal and diffuse infarction. Focal infarction has been ascribed to thromboembolic events, whereas a diffuse pattern of cerebral injury has been attributed to hypotension and hypoperfusion.11 More recent neuropathological data in infants who underwent reparative or palliative cardiac surgery reveals that not only are these children at increased risk of gray matter injury but also nascent white matter is at risk. For instance, in a series of infants who died after cardiac surgery, cerebral white matter damage (periventricular leukomalacia or diffuse white matter gliosis) was the most significant lesion in terms of severity and incidence. 12 Similarly, MRI performed in patients with congenital heart disease after surgery has revealed findings consistent with both gray matter injury and widely distributed white matter injury. 13 Risk factors for brain injury during infant heart surgery have been particularly well studied. Cardiopulmonary bypass carries the risks of particulate and gaseous microemboli, macroemboli, and hypoperfusion with accompanying diffuse ischemia/reperfusion injury. In neonates and infants undergoing surgery with use of hypothermic bypass techniques, the risk of brain injury may be influenced by perfusion variables such as the duration of total circulation arrest,14 the depth of hypothermia, 15 the rate and duration of core cooling, 16 pH management during core cooling (alpha-stat versus pH stat), 17,18 and the level of hemodilution. 19 Disruption of cerebral vasoregulation in the early postoperative period renders the brain more vulnerable to hemodynamic instability. 20–22 After infant heart surgery, longer length of stay in the intensive care unit or hospital is associated with worse neurodevelopmental outcome on mid-term follow-up. 23,24

Outcome at 2 years for very low birthweight infants in a geographical population: Risk factors, cost, and impact of congenital anomalies

Aim To determine the type and rate of disability at 2 years of age in infants born in the geographically defined population of East Anglia with a birthweight less than 1500 g and to assess the risk factors for disability. Study design A prospective cohort analysis from all eight neonatal units in East Anglia from 1993–1997 using a single database. Methods Local paediatricians assessed children at 2 years using the Health Status Questionnaire and data collection was centrally coordinated. Results Outcomes for 947 children, 99% of survivors, were available, 74 (7.8%) had severe disability and this was significantly associated with gestational age ( p < 0.0005), birthweight ( p < 0.0005) and sex ( p = 0.046). Major congenital abnormality contributed 27% of all severe disability. The overall cerebral palsy rate was 6.2%, nine children were blind and five had sensorineural hearing loss requiring aids. These children had a high level of use of community services with 19% of the cohort being referred to one or more community service. ELBW infants or those born < 30 weeks gestation were 1.5 times and twice as likely to have moderate or severe disability and 2.3 and 5.4 times as likely to have cerebral palsy as those weighing 1000 to 1500 g or > 30 weeks gestation. Boys were at higher risk of adverse outcome. Conclusions The study was able to define the increased risk associated with being born at lower gestational age or lower birthweight and demonstrates successful ascertainment of outcomes for large local populations at a reasonable cost.

Neurological assessment at five years of age in infants born preterm

To evaluate the agreement between Touwen's neurological examination and a derived simplified one, created to be applied at the age of 5 y to infants born preterm. 185 children born at a gestational age (GA) of <33 wk and/or with a birthweight <1501 g, free of cerebral palsy, underwent Touwen's neurological examination at a mean age of 5 y and 8 mo (5-6.5 y). One-hundred and seventy had a full examination and were included into the study. They were born at a mean GA of 30 wk (range 24-35 wk) with a mean birthweight of 1250 g (range 600-2690 g). A simplified examination, based on the clinical experience of two of the authors, was created a priori. The data were reviewed retrospectively and the concordance between the two forms was assessed. The reviewers were blinded to the original categorization from the long form. On the basis of the original Touwen's neurological examination, the 170 children were classified into 122 with a normal neurological examination, 41 with grade 1 minor neurological dysfunction (MND) and 7 with grade 2 MND, giving 28% of the cohort with MND. The concordance between the two forms was excellent, with an agreement in 169 out of 170 subjects. None of the infants with the most complex form of MND was misclassified. The simplicity of this examination could allow its diffusion and its use in follow-up programmes. It could improve the quality of routinely collected follow-up data of preterm neonates.

Neurological assessment at five years of age in infants born preterm

Neurological assessment at five years of age in infants born preterm

Health Status and Educational Outcome at 14-15 Years of Age for Infants &lt;801 g BW

Health Status and Educational Outcome at 14-15 Years of Age for Infants &lt;801 g BW

Abnormal magnetic resonance signal in the internal capsule predicts poor neurodevelopmental outcome in infants with hypoxic-ischemic encephalopathy.

The aim of this study was to establish whether abnormal signal intensity in the posterior limb of the internal capsule (PLIC) on magnetic resonance imaging is an accurate predictor of neurodevelopmental outcome at 1 year of age in infants with hypoxic-ischemic encephalopathy (HIE). We have examined 73 term neonates with HIE between 1 and 17 days after birth with cranial magnetic resonance imaging and related the magnetic resonance imaging findings to neurodevelopmental outcome at 1 year of age. All infants with an abnormal signal intensity in the PLIC developed neurodevelopmental impairment although in 4 infants with very early scans the abnormal signal was not apparent until up to 4 days after birth. A normal signal intensity was associated with a normal outcome in all but 4 cases; 3 of these infants had minor impairments and all had persistent imaging changes within the white matter. The 4th infant with a normal signal intensity on day 2 died before a further image could be obtained. The absence of normal signal predicted abnormal outcome in term infants with HIE with a sensitivity of 0.90, a specificity of 1.0, a positive predictive value of 1.0, and a negative predictive value of 0.87. The test correctly predicted outcome in 93% of infants with grade II HIE, according to the Sarnat system. Applying a Bayesian approach, the predictive probability of the test (the probability that the test would predict an outcome correctly) was distributed with a mean of 0.94 and 95% confidence limits of 0.89 to 1.0. Abnormal signal intensity in the PLIC is an accurate predictor of neurodevelopmental outcome in term infants suffering HIE.

Lung Function at 8 and 14 Years of Age in Infants of Birthweight &lt;1501 g† 1643

Lung Function at 8 and 14 Years of Age in Infants of Birthweight &lt;1501 g† 1643

Neurodevelopmental outcome in babies with a low Apgar score from Zimbabwe.

The early identification of neurological dysfunction in the neonatal period, the predictive value of single items of the neonatal neurological examination (NNE) adapted from Prechtl and the developmental outcome at 1 year of age in infants with a low Apgar score in Zimbabwe were studied. One hundred and sixty-five infants were examined with the NNE and 142 with the Bayley Scale of Infant Development (BSID) at 1 year of age. Twenty-three infants had cerebral palsy, ten had a motor delay or developmental delay, and four were mentally retarded. The NNE proved to be a sensitive instrument for detecting neurodevelopmental abnormality. Logistic regression analysis was used to investigate the relationship between the BSID and nine selected predictors from the NNE. This resulted in a correct classification of 94%. However, the number of false negatives was high. By using only the variability of movements and fixation as predictors the number of false negatives was reduced to one.

Shortened survival in infants vertically infected with human immunodeficiency virus with elevated p24 antigenemia

Objective: To determine whether the amount of p24 antigenemia in the first 6 months of life is a predictor of survival in children infected vertically with human immunodeficiency virus type 1. Methods: A retrospective study of vertically infected infants and children who were followed prospectively from early infancy and who had quantitation of plasma p24 antigen concentration in the first 6 months of life. Infants were first stratified by duration of survival as infants who died before 2 years of age (short-term survivors) and infants who survived to 2 years of age (intermediate-term survivors). The median p24 antigen concentration and the proportion of infants in each group with high concentrations of antigen were compared. Analyses with and excluding all p24 determinations made after the use of antiretroviral agents were compared. Kaplan-Meier product limit analysis was used to compare survival in infants with low and high antigenemia during the first 6 months of life. Results: The median p24 antigen concentration in 15 short-term survivors was 228 pg/ml, compared with 14 pg/ml in 26 intermediate-term survivors ( p <0.05). The proportion of children with >100 pg/ml of p24 was higher in short-term than in intermediate-term survivors ( p = 0.01). Survival to 2 years of age in infants in whom all p24 antigen values during the first 6 months of life were 100 pg/ml or less was 91%, in comparison with 39% in infants with values greater than 100 pg/ml ( p = 0.0017). Conclusions: Elevated p24 antigenemia in the first 6 months of life is associated with shorter survival and may be a useful predictor of outcome. (J P EDIATR 1995;127:538-43)

Sex Difference in Disability and Handicap at Five Years of Age in Children Born at Very Short Gestation

The objective of this study was to examine the relationship between sex and disabilities or handicaps at 5 years of age in infants born at less than 32 weeks gestation. From the nationwide collaborative survey starting in 1983, including perinatal data obtained during routine perinatal care and follow-up assessments by the attending pediatricians, data from 1008 infants fulfilling the criteria were used. At age 5 years, a detailed assessment was performed by three specially trained pediatricians in 96% surviving infants (n = 648), of which 345 were boys. Each child was categorized as disabled or handicapped, using World Health Organization definitions. The prevalence of handicaps was three times greater in boys than in girls (21% vs 7%, odds ratio 3.2). Adjustment for gestational age and birth weight (logistic regression analysis) did not change this (odds ratio 3.5). Further adjustment by including perinatal variables such as idiopathic respiratory distress syndrome did not alter the odds ratios. The male excess in handicaps was not related to lower mortality, and therefore was not a mere consequence of a higher survival rate. The excess in handicaps was found in all assessed areas. Infants' sex seems to be an important determinant of handicaps. The perinatal variables used in the present study do not explain the difference in handicaps. These findings emphasize the need to include the sex distribution of a study population more systematically in analyses in future studies concerning long-term outcome of very preterm birth or low birth weight.

Development of nasal basophilic cells and nasal eosinophils from age 4 months through 4 years in children of atopic parents

Background : The importance of the inflammatory response in allergic disease has warranted investigation of two of the more integral cells in the pathogenesis of allergic rhinitis, namely, nasal basophilic cells (NBCs) and nasal eosinophils (NEs). In the present study the natural history of NBCs and NEs was studied from birth through 4 years of age in infants of atopic parents to better understand their relationship to the development of various atopic disorders. Methods : During a prospective, randomized, controlled trial of the effect of maternal and infant food avoidance on the development of atopic disorders in 288 infants of atopic parents, NBCs and NEs were determined semiquantitatively on Wright-Geimsa stained nasal mucosal scrapings and related to each other and to various atopic parameters. Results : In these infants who are at high risk NBCs developed in both those becoming atopic and those remaining nonatopic, but they occurred with increased frequency and quantity in those children in whom most allergic disorders and food or inhalant sensitization developed. NEs, rare at 4 months in all infants, increased in atopic children from 1 to 4 years, and remained infrequent and nominal in nonatopic children. Levels of NBCs and NEs (1) correlated with each other strongly, directly, and with increasing magnitude in children from ages 4 months to 4 years and (2) correlated with log serum IgE levels weakly and moderately in children from ages 2 to 4 years. Stepwise linear regression analyses revealed that allergic rhinitis accounted for most of the variance seen in the level of NBCs and NEs during early childhood, reaching 50% by age 4 years. Asthma, atopic dermatitis, food allergy, food and inhalant sensitization, serum IgE level, and IgG beta-lactoglobulin level accounted for a small proportion of the variance in NBCs and NEs from ages 4 months to 4 years. Conclusions : These findings help to elucidate the natural history of NBCs and NEs in infants at risk for atopic disorders and document the temporal association of these cells with the development of atopic disease, principally allergic rhinitis.