Article

Neurodevelopmental Outcome of the Premature Infant

Department of Pediatrics, Women and Infants Hospital, The Warren Alpert Medical School of Brown University, Providence, RI 02905, USA.
Pediatric Clinics of North America (Impact Factor: 2.2). 06/2009; 56(3):631-46, Table of Contents. DOI: 10.1016/j.pcl.2009.03.005
Source: PubMed

ABSTRACT Advances in antenatal medicine and neonatal intensive care have successfully resulted in improved survival rates of preterm infants. These improvements have been most dramatic in infants born extremely low birth weight (ELBW, <or=1000 g) and at the limits of viability (22 to 25 weeks). But improvements in survival have not been accompanied by proportional reductions in the incidence of disability in this population. Thus, survival is not an adequate measure of success in these infants who remain at high risk for neurodevelopmental and behavioral morbidities. There is now increasing evidence of sustained adverse outcomes into school age and adolescence, not only for ELBW infants but for infants born late preterm.

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    • "Though mean IQ scores of children born VLBW have been shown to be up to 10 points below those of matched full-term peers [3], most fall within the average range when major disabilities are excluded [4] [5] [6]. A construct that may be more sensitive to deficits found among children born VLBW is executive function (EF), which refers to the cognitive processes that underlie flexible, goal directed responses to novel situations [8] including working memory, inhibitory control, and cognitive flexibility [9] [10] [11]. "
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    ABSTRACT: Background Deficits in executive function, including measures of working memory, inhibition and cognitive flexibility, have been documented in preschoolers born very low birth weight (VLBW) compared with preschoolers born normal birth weight (NBW). Maternal verbal scaffolding has been associated with positive outcomes for both at-risk and typically developing preschoolers. Aims The purpose of this study was to examine associations between maternal verbal scaffolding, Verbal IQ (VIQ) and executive function measures in preschoolers born VLBW. Subjects A total of 64 VLBW and 40 NBW preschoolers ranging in age from 3 ½ to 4 years participated in the study. Outcome measures VIQ was measured with the Wechsler Preschool and Primary Scale of Intelligence — Third Edition. Executive function tests included the Bear Dragon, Gift Delay Peek, Reverse Categorization and Dimensional Change Card Sort-Separated Dimensions. Study design Maternal verbal scaffolding was coded during a videotaped play session. Associations between maternal verbal scaffolding and preschoolers' measures of VIQ and executive function were compared. Covariates included test age, maternal education, and gender. Results Preschoolers born VLBW performed significantly worse on VIQ and all executive function measures compared to those born NBW. Maternal verbal scaffolding was associated with VIQ for VLBW preschoolers and Gift Delay Peek for the NBW group. Girls born VLBW outperformed boys born VLBW on VIQ and Bear Dragon. Conclusion Integrating scaffolding skills training as part of parent-focused intervention may be both feasible and valuable for early verbal reasoning and EF development.
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    • "Though mean IQ scores of children born VLBW have been shown to be up to 10 points below those of matched full-term peers [3], most fall within the average range when major disabilities are excluded [4] [5] [6]. A construct that may be more sensitive to deficits found among children born VLBW is executive function (EF), which refers to the cognitive processes that underlie flexible, goal directed responses to novel situations [8] including working memory, inhibitory control, and cognitive flexibility [9] [10] [11]. "
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    ABSTRACT: Background: Deficits in executive function, including measures of working memory, inhibition and cognitive flexibility, have been documented in preschoolers born very low birth weight (VLBW) compared with preschoolers born normal birth weight (NEW). Maternal verbal scaffolding has been associated with positive outcomes for both at-risk and typically developing preschoolers. Aims: The purpose of this study was to examine associations between maternal verbal scaffolding, Verbal IQ (VIQ) and executive function measures in preschoolers born VLBW. Subjects: A total of 64 VLBW and 40 NBW preschoolers ranging in age from 3 1/2 to 4 years participated in the study. Outcome measures: VIQ was measured with the Wechsler Preschool and Primary Scale of Intelligence Third Edition. Executive function tests included the Bear Dragon, Gift Delay Peek, Reverse Categorization and Dimensional Change Card Sort-Separated Dimensions. Study design: Maternal verbal scaffolding was coded during a videotaped play session. Associations between maternal verbal scaffolding and preschoolers' measures of VIQ and executive function were compared. Covariates included test age, maternal education, and gender. Results: Preschoolers born VLBW performed significantly worse on VIQ and all executive function measures compared to those born NBW. Maternal verbal scaffolding was associated with VIQ for VLBW preschoolers and Gift Delay Peek for the NBW group. Girls born VLBW outperformed boys born VLBW on VIQ and Bear Dragon. Conclusion: Integrating scaffolding skills training as part of parent-focused intervention may be both feasible and valuable for early verbal reasoning and EF development.
    Early Human Development 08/2014; 90(10):587-593. DOI:10.1016/j.earlhumdev.2014.07.009 · 1.93 Impact Factor
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    • "Infants cared for in neonatal intensive care units (NICUs) are at increased risk for abnormal brain development and contribute disproportionately to the burden of developmental disabilities [1-5]. Interruption of normal development imposed by premature birth can be magnified by disruptions in neurologic development caused by environmental toxins, medical insults and nutritional deficits [6,7]. "
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    ABSTRACT: Magnetic resonance imaging (MRI) is a useful tool to study brain growth and organization in preterm neonates for clinical and research purposes, but its practicality can be limited by time and medical constraints. The aim of this study was to determine if MRI relaxometry of the deep nuclei, as opposed to white matter, would reflect the influence of gestational age at birth on structures essential to motor development, regardless of postnatal age at the time of imaging. This was a prospective observational study of infants without brain injury on conventional neuroimaging who were cared for in the neonatal intensive care unit (NICU) at Vanderbilt. Infants were studied using MRI relaxometry within a 2-month window of postmenstrual term age. In 45 infants, white matter MRI T1 relaxation times were influenced by both gestational age and postnatal age at imaging time (R2 = 0.19 for gestational age vs. R2 = 0.34 adjusting for both gestational age and age at imaging; all p < 0.01). Similar results were obtained with T2 relaxation times. In contrast, globus pallidus T1 reflected gestational age but was minimally affected by postnatal age (R2 = 0.50 vs. 0.57, p < 0.001). The results obtained using this imaging protocol are consistent with the slow maturation of the globus pallidus, essential to normal development of complex motor programs into adulthood. Globus pallidus MRI relaxometry measures the impact of gestational age at birth on brain development independent of postnatal age in preterm infants and should prove useful for predictive modeling in a flexible time-window around postmenstrual term age.
    BMC Pediatrics 03/2014; 14(1):84. DOI:10.1186/1471-2431-14-84 · 1.92 Impact Factor
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