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ABSTRACT: OBJECTIVE:Research is required to monitor changes in the nature of neurobehavioral deficits in extremely preterm (EP) or extremely low birth weight (ELBW) survivors. This study examines cognitive, academic, and behavioral outcomes at age 8 years for a regional cohort of EP/ELBW children born in 1997.METHODS:The EP/ELBW cohort comprised all live births with a gestational age <28 weeks (EP) or birth weight <1000 g (ELBW) born in the state of Victoria, Australia, in 1997. Of 317 live births, 201 (63.4%) survived to 2 years of age. A term/normal birth weight (T/NBW) cohort was recruited comprising 199 infants with birth weights <2500 g or gestational age <37 weeks. Measures of intellectual ability, educational achievement, and behavior were administered at age 8.RESULTS:Retention was 94% for the EP/ELBW group and 87% for the T/NBW group. The EP/ELBW group performed poorer than the T/NBW group on measures of IQ, educational achievement, and certain behavioral domains, even after adjustment for sociodemographic factors and exclusion of children with neurosensory impairment. The rate of any neurobehavioral impairment was elevated in the EP/ELBW group (71% vs 42%), and one-half of subjects had multiple impairments. The outcomes for those with <750 g birth weight or <26 weeks' gestational age were similar to those with a birth weight of 750 to 999 g or a gestational age of 26 to 27 weeks, respectively.CONCLUSIONS:Despite ongoing improvements in the management of EP/ELBW infants, the rate of neurobehavioral impairment at school-age remains too high relative to controls.
PEDIATRICS 03/2013; · 4.47 Impact Factor
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ABSTRACT: OBJECTIVES:To determine changes in height, weight, and BMI of extremely preterm (EPT; gestational age <28 completed weeks) survivors from birth to 18 years of age, compared with term controls.METHODS:Birth, discharge, and follow-up at ages 2, 5, 8, and 18 years of consecutive EPT survivors and contemporaneous term controls born in 1991-1992 in Victoria, Australia. Weight, height, and BMI were converted to z scores and compared between groups. Height z scores at age 2 and midparental height z scores were examined as predictors of height z score at age 18 years.RESULTS:Follow-up rates were >90% until 18 years, when 166 (74%) of 225 EPT subjects and 153 (60%) of 253 controls were assessed. EPT subjects had lower weight z scores than controls at birth, with a much greater difference at discharge, which reduced progressively until age 18 years. EPT children were shorter than controls at all ages, and this difference did not alter greatly over time. BMI z scores were lower in EPT children at younger ages, but by age 18 were similar between groups. Height at age 2 was a better predictor of height at age 18 in EPT participants, compared with midparental height.CONCLUSIONS:EPT survivors were substantially lighter than term controls from birth to late adolescence, although the gap in weight steadily decreased over time from a peak at the time of discharge. The height disadvantage in EPT children compared with controls remained constant over time and BMI scores were similar at age 18 years.
PEDIATRICS 01/2013; · 4.47 Impact Factor
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ABSTRACT: The hippocampus undergoes rapid growth and development in the perinatal months. Infants born very preterm (VPT) are vulnerable to hippocampal alterations, and can provide a model of disturbed early hippocampal development. Hippocampal shape alterations have previously been associated with memory impairment, but have never been investigated in infants. The aims of this study were to determine hippocampal shape differences between 184 VPT infants (<30weeks' gestation or <1250g at birth) and 32 full-term infants, effects of perinatal factors, and associations between infant hippocampal shape and volume, and 7year verbal and visual memory (California Verbal Learning Test- Children's Version and Dot Locations). Infants underwent 1.5T magnetic resonance imaging at term equivalent age. Hippocampi were segmented, and spherical harmonics-point distribution model shape analysis was undertaken. VPT infants' hippocampi were less infolded than full-term infants, being less curved toward the midline and less arched superior-inferiorly. Straighter hippocampi were associated with white matter injury and postnatal corticosteroid exposure. There were no significant associations between infant hippocampal shape and 7year memory measures. However, larger infant hippocampal volumes were associated with better verbal memory scores. Altered hippocampal shape in VPT infants at term equivalent age may reflect delayed or disrupted development. This study provides further insight into early hippocampal development and the nature of hippocampal abnormalities in prematurity.
NeuroImage 01/2013; · 5.89 Impact Factor
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ABSTRACT: OBJECTIVE: Postnatal corticosteroids (PCS) are used to prevent or treat bronchopulmonary dysplasia (BPD) in extremely low birthweight (ELBW; <1000 g) or extremely preterm (EPT; <28 weeks) infants. In the early 2000s, concerns were raised about increased risks of cerebral palsy (CP) in association with PCS, which may have affected prescribing of PCS, and influenced rates of BPD, mortality or long-term neurosensory morbidity. Our aim was to determine the changes over time in the rates of PCS use and 2-year outcomes in ELBW/EPT infants in Victoria, Australia. DESIGN: All ELBW or EPT infants born in Victoria, Australia in three distinct eras (1991-92, 1997 and 2005) who were alive at 7 days were included. Rates of PCS use, rates of BPD (oxygen dependency at 36 weeks' corrected age), death before 2 years of age, CP and major disability (any of moderate/severe CP, developmental quotient <-2 SD, blindness or deafness) were contrasted between cohorts. RESULTS: The rate of PCS use and the dose prescribed diminished significantly in 2005 compared with earlier eras, but the rate of BPD rose. Non-significant changes in the rates of mortality over time were mirrored by non-significant changes in the rates of CP or major disability. Combined outcomes of mortality with either major disability or CP were similar over the three eras. CONCLUSIONS: PCS use decreased in 2005 compared with earlier eras, and was accompanied by a rise in BPD, with no significant changes in mortality or neurological morbidity.
Archives of Disease in Childhood - Fetal and Neonatal Edition 06/2012; · 3.05 Impact Factor
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ABSTRACT: Aim: Children with learning difficulties are commonly seen in Australian paediatric outpatient settings. The practice patterns of paediatricians in assessing, referring and managing these children are unknown, and there is no consensus on best practice. We thus aimed to examine the consistency between Australian paediatricians': (i) assessment; (ii) referral; and (iii) management of children presenting with learning difficulties. Methods: All 373 paediatrician members of the Australian Paediatric Research Network were invited to participate in an online survey in 2010. Paediatricians who saw children with learning difficulties were asked questions about their assessment, referral and management practices. Results: Of 181 (49%) paediatricians to complete the survey, 140 (77%) reported seeing patients with learning difficulties. Most often, paediatricians supplemented their clinical assessments with audiology assessments (75%), teacher or parent questionnaires (60-65%), or teacher contact (51%). Paediatricians used medical investigations (40%), direct assessment tools (27%) or a school visit (4%) less often. Most paediatricians referred children with learning difficulties to educational psychology (84%), special education (61%) or speech therapy (66%) services but less often to occupational therapy (34%) or mental health (15%) services. The most common management strategies were to provide a report to the school (76%) or parents (66%) and to make recommendations around sleep hygiene (75%) and for tutoring (66%). Conclusions: Australian paediatric practice in this area is diverse, with the greatest variability around management practices. These data provide a case for designing and implementing evidence-based guidelines for the paediatric care of children who struggle to learn in school.
Journal of Paediatrics and Child Health 05/2012; · 1.28 Impact Factor
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ABSTRACT: Very preterm children have increased risk for social-emotional problems. This study examined relationships between early social-emotional difficulties and later social-emotional problems, and whether this differed by group (very preterm or term).
Participants were 189 children born less than 30 weeks gestation or less than 1,250 g at birth and 78 term-born children. Parent-report questionnaires were used to assess social-emotional development at 2 (infant toddler social emotional assessment) and 5 years of age (strengths and difficulties questionnaire). Social risk and children's cognitive development were collected at the age of 5 years.
Emotional symptoms at the age of 5 years were predicted by internalizing problems at the age of 2 years, conduct problems and hyperactivity/inattention at the age of 5 years were predicted by externalizing problems at the age of 2 years, and peer relationship problems and prosocial behaviors at the age of 5 years were predicted by social-emotional competence at the age of 2 years. Relationships were not moderated by group.
Implications for early detection of social-emotional problems and provision of targeted interventions are discussed.
Journal of Pediatric Psychology 03/2012; 37(7):779-85. · 2.91 Impact Factor
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ABSTRACT: Preterm children are at risk for social-emotional difficulties, including autism and attention-deficit/hyperactivity disorder. We assessed the relationship of regional brain development in preterm children, evaluated via magnetic resonance imaging (MRI) at term-equivalent postmenstrual age (TEA), to later social-emotional difficulties.
MR images obtained at TEA from 184 very preterm infants (gestation <30 weeks or birth weight <1,250 g) were analyzed for white matter abnormalities, hippocampal volume, and brain metrics. A total of 111 infants underwent diffusion tensor imaging, which provided values for fractional anisotropy and apparent diffusion coefficient. Social-emotional development was assessed with the Infant Toddler Social and Emotional Assessment (ITSEA) at age 2 and the Strengths and Difficulties Questionnaire (SDQ) at age 5 years.
Higher apparent diffusion coefficient in the right orbitofrontal cortex was associated with social-emotional problems at age 5 years (peer problems, p < .01). In females, smaller hippocampal volume was associated with increased hyperactivity (p < .01), peer problems (p < .05), and SDQ total score (p < .01). In males, a smaller frontal region was associated with poorer prosocial (p < .05) scores. Many of the hippocampal findings remained significant after adjusting for birthweight z score, intelligence, social risk, immaturity at birth, and parental mental health. These associations were present in children who had social-emotional problems in similar domains at age 2 and those who did not.
Early alterations in regional cerebral development in very preterm infants relate to specific deficits in social-emotional performance by school-age. These results vary by gender. Our results provide further evidence for a neuroanatomical basis for behavioral challenges found in very preterm children.
Journal of the American Academy of Child and Adolescent Psychiatry 02/2012; 51(2):181-91. · 4.98 Impact Factor
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ABSTRACT: Children born very preterm are at risk for impaired motor performance ranging from cerebral palsy (CP) to milder abnormalities, such as developmental coordination disorder. White matter abnormalities (WMA) at term have been associated with CP in very preterm children; however, little is known about the impact of WMA on the range of motor impairments. The aim of this study was to assess whether WMA were predictive of all levels of motor impairments in very preterm children.
Two hundred and twenty-seven very preterm infants (< 30 wks gestational age or birthweight < 1250 g) had brain magnetic resonance imaging at term-equivalent age to assess for WMA, which were categorized as nil, mild, or moderate to severe. At 5 years of age children were classified as having a moderate to severe motor impairment if they were below the 5th centile or mild to severe motor impairment if their score placed them no higher than the 15th centile on the Movement Assessment Battery for Children (MABC). WMA (nil vs mild and nil vs moderate-severe) were explored as predictors of motor impairment using logistic regression. Analyses were repeated adjusting for the effects of other perinatal variables and excluding children with CP.
Of the 193 very preterm children (97 males, 96 females) assessed with the MABC, 53 (27%) were classified as having a moderate to severe motor impairment and 96 (50%) a mild to severe motor impairment. WMA were predictive of motor impairment in very preterm children, with mild versus no WMA increasing the odds of moderate to severe motor impairment by over fivefold (odds ratio [OR] 5.6; 95% confidence interval [CI] 1.9-16.1; p=0.002) and mild to severe impairment by twofold (OR 2.2; 95% CI 1.1-4.2; p=0.02). Compared with no WMA, moderate to severe WMA increased the odds for moderate to severe impairment 19-fold (OR 19.4; 95% CI 5.6-66.7; p<0.001) and for mild to severe motor impairment ninefold (OR 9.4; 95% CI 3.2-28.1; p<0.001). Results remained similar after controlling for several potential confounders and after excluding 14 children who had CP at age 2 years.
WMA predict motor impairment at 5 years, with rates of impairment increasing with more severe WMA. Very preterm children with any WMA at term require follow-up throughout childhood.
Developmental Medicine & Child Neurology 11/2011; 53(11):1000-6. · 2.92 Impact Factor
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ABSTRACT: Extremely preterm and extremely low-birthweight (EP/ELBW) children (<28 completed weeks' gestation; birthweight <1000g) have a high risk of long-term adverse outcomes. Clinical developmental surveillance is difficult to achieve for all of these children. Our aim was to study the ability of two parent-completed questionnaires to differentiate health status of EP/ELBW children from that of a comparison group of children born at term, and to screen EP/ELBW children for disability compared with the ability of a multidisciplinary clinical assessment.
A geographic cohort of 189 EP/ELBW children (100 males, 89 females) and a comparison group of 173 term children (92 males, 81 females) born in 1997 were assessed at the age of 8 years using parent questionnaires (the Child Health Questionnaire [CHQ] and the Health Utilities Index Mark 2 [HUI2]) and a multidisciplinary clinical assessment. The questionnaires and clinical assessment were compared with respect to their ability to differentiate between the health status of EP/ELBW children and children born at term and also to identify children with a disability.
The HUI2 was better than the CHQ at differentiating the health status of EP/ELBW and comparison children. Moderate and severe disability status were identified by the HUI2 with sensitivity ranging from 86 to 97%, specificity from 60 to 64%, positive predictive values from 34 to 39%, and negative predictive values from 95 to 99%.
The HUI2 had suitable sensitivity and specificity to be used as a developmental screening tool for EP/ELBW children, but the CHQ did not. Given its low positive predictive values, however, the HUI2 should be viewed with caution as a final outcome measure for intervention trials, and would be better used to identify at-risk children who need a definitive clinical assessment.
Developmental Medicine & Child Neurology 07/2011; 53(10):927-32. · 2.92 Impact Factor
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ABSTRACT: Low academic achievement is common and is associated with adverse outcomes such as grade repetition, behavioural disorders and unemployment. The ability to accurately identify these children and intervene before they experience academic failure would be a major advance over the current 'wait to fail' model. Recent research suggests that a possible modifiable factor for low academic achievement is working memory, the ability to temporarily store and manipulate information in a 'mental workspace'. Children with working memory difficulties are at high risk of academic failure. It has recently been demonstrated that working memory can be improved with adaptive training tasks that encourage improvements in working memory capacity. Our trial will determine whether the intervention is efficacious as a selective prevention strategy for young children at risk of academic difficulties and is cost-effective.
This randomised controlled trial aims to recruit 440 children with low working memory after a school-based screening of 2880 children in Grade one. We will approach caregivers of all children from 48 participating primary schools in metropolitan Melbourne for consent. Children with low working memory will be randomised to usual care or the intervention. The intervention will consist of 25 computerised working memory training sessions, which take approximately 35 minutes each to complete. Follow-up of children will be conducted at 6, 12 and 24 months post-randomisation through child face-to-face assessment, parent and teacher surveys and data from government authorities. The primary outcome is academic achievement at 12 and 24 months, and other outcomes include child behaviour, attention, health-related quality of life, working memory, and health and educational service utilisation.
A successful start to formal learning in school sets the stage for future academic, psychological and economic well-being. If this preventive intervention can be shown to be efficacious, then we will have the potential to prevent academic underachievement in large numbers of at-risk children, to offer a ready-to-use intervention to the Australian school system and to build international research partnerships along the health-education interface, in order to carry our further studies of effectiveness and generalisability.
BMC Pediatrics 06/2011; 11:57. · 1.88 Impact Factor
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ABSTRACT: Examining rates of difficulties in family functioning following very preterm birth has been a relatively neglected area of research.
To examine family functioning, burden and parenting stress in families with very preterm compared with term born children, and investigate influences of parental mental health problems and child neurodevelopmental disability on family outcomes in families with preterm children.
Participants were 184 very preterm and 71 term children and their parents. Parents completed the Family Assessment Device, Parenting Stress Index and Impact on Family questionnaires when their children were 2 years old (corrected for prematurity). Parental mental health and social risk information were also collected. Children were assessed for neurodevelopmental disability.
Families with very preterm children reported poorer family functioning (p=.03) compared with families with term born children, with less evidence for differences between families with very preterm and term born children in parenting stress and family burden. Within very preterm families, parental mental health problems were associated with higher levels of parenting stress (p=.001), and parents of children with a neurodevelopmental disability were more likely to report higher family burden (p=.04).
For families with very preterm children, parental mental health symptoms and child neurodevelopmental disability may identify families at risk of greater stress and burden who may benefit from additional support.
Early human development 06/2011; 87(6):427-31. · 2.12 Impact Factor
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ABSTRACT: : Developmental/behavioral diagnoses are common in pediatric practice but, until the impact on pediatricians of caring for these children is quantified, training and remuneration barriers are unlikely to be addressed. In a prospective audit of Australian office-based pediatricians, developmental-behavioral and medical consultations were examined regarding (1) consultation characteristics, (2) child and parent health, and (3) referrals and investigations ordered.
: In 2008, all 300 eligible members of the nationwide Australian Paediatric Research Network were invited to prospectively record standardized information for every consultation over 2 weeks or 100 consecutive patients, whichever came first. After coding all diagnoses, consultations were classified as developmental/behavioral, medical, or "mixed." These groups were compared using simple 3-group comparisons (Aims 1 and 2) and logistic regression (Aim 3).
: One hundred ninety-nine (66%) pediatricians recorded 15,360 diagnoses for 8,335 consultations (34% developmental/behavioral, 48% medical, and 18% mixed). Compared with medical patients, developmental/behavioral patients were older, more likely to be male, and required on average ∼9 minutes more time per consultation; self-reported parent health was worse; and referrals were more common (odds ratio 2.2, 95% confidence interval 1.9 to 2.5; p < .0001), but investigations less common (odds ratio 0.4, 95% confidence interval 0.3 to 0.4; p < .0001). Child health was worst in the "mixed" group.
: Developmental/behavioral consultations are common in pediatric office settings. They are time-consuming, often lead to referrals, and the worse health reported by their parents may pose additional challenges. Pediatric training and funding models must address these barriers if adequate and comprehensive care is to be accorded to these complex patients.
Journal of developmental and behavioral pediatrics: JDBP 06/2011; 32(5):368-74. · 2.27 Impact Factor
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ABSTRACT: To audit general paediatric outpatient practice in Australia, including consultation characteristics and management patterns, diagnoses, factors associated with diagnoses, and billing practices.
In October-November 2008, members of the Australian Paediatric Research Network (APRN; a national network of paediatricians established to facilitate multisite secondary care research) were invited to prospectively complete brief standardised data collection forms for 100 consecutive patients or all patients during a 2-week period, whichever came first.
Length of consultation and type of diagnoses made; proportions recorded as having medications, investigations or referral; odds ratios for factors associated with diagnoses; and proportions of Medicare items billed.
Of 300 APRN members, 199 (66%) completed data forms for 8345 consultations in which 15 375 diagnoses were made (mean, 1.8 diagnoses per consultation); 46.0%, 30.9% and 22.8% of consultations involved 1, 2 and ≥ 3 diagnoses, respectively. New and review consultations lasted a mean of 41 (SD, 20) and 26 (SD, 15) minutes, respectively. The most common diagnoses were attention deficit hyperactivity disorder (18.3%), baby checks (9.1%), and learning difficulties (7.5%). Patients seen in 47.5% of consultations had medications (eg, prescriptions, vaccinations) recorded, and patients in 27.2% of consultations were referred elsewhere, usually to a subspecialist or psychologist (31.6% and 26.6% of referrals, respectively). Male sex of the child and owning a Health Care Card were associated with most developmental-behavioural diagnoses. Paediatricians tended to bill for single disease/non-complex consultations, even when seeing a child with multiple problems.
Australian paediatricians see children with a range of diagnoses that are often multiple and complex. Our findings provide directions for future secondary care research, and may inform workforce planning and paediatricians' training requirements.
The Medical journal of Australia 04/2011; 194(8):392-7. · 2.81 Impact Factor
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Kelly Howard, Gehan Roberts,
Jeremy Lim,
Katherine J Lee,
Natalie Barre,
Karli Treyvaud,
Jeanie Cheong,
Rod W Hunt,
Terri E Inder,
Lex W Doyle,
Peter J Anderson
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ABSTRACT: Language problems are thought to occur more frequently in very preterm children compared with healthy term born children. The primary aim of this study was to examine the contributions of biological and environmental risk factors to language outcomes in very preterm children at 5 years of age.
A cohort of 227 very preterm infants (birth weight <1250 g or gestational age <30 weeks) were recruited at birth and followed up at 2 and 5 years of age (corrected for prematurity) in a prospective, longitudinal study in Melbourne, Australia. Outcomes at 5 years of age were the Expressive and Receptive Language Scales from the Kaufman Survey of Early Academic and Language Skills. A range of hypothesized biological and environmental factors identified from past research were examined as predictors of language outcomes at 5 years of age using linear regression models.
Lower maternal education and poorer communication skills in the child at 2 years of age were predictive of poorer expressive and poorer receptive language outcomes at 5 years of age. Lower expressive language scores were also associated with the presence of moderate-severe white matter abnormalities on neonatal magnetic resonance imaging.
Results support the role of both biological and environmental factors in the evolution of language difficulties and highlight the need to consider these factors in the follow-up of preterm infants.
Journal of developmental and behavioral pediatrics: JDBP 04/2011; 32(3):239-49. · 2.27 Impact Factor
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ABSTRACT: The aim of this study was to examine attention in a large, representative, contemporary cohort of children born extremely preterm (EP) and/or extremely low birth weight (ELBW). Participants included 189 of 201 surviving children born EP (<28 weeks' gestation) or ELBW (<1,000 g) in 1997 in the state of Victoria, Australia. A comparison group of 173 of 199 children born full term and normal birth weight (FT/NBW) were randomly selected matching for birth hospital, expected due date, gender, mother's country of birth, and health insurance status. Participants were assessed at 8 years of age on subtests from the Test of Everyday Attention for Children (TEA-Ch) and the Wechsler Intelligence Scale for Children-4th Edition (WISC-IV). Measures of selective attention, sustained attention, attention encoding, and executive attention (inhibition, shifting attention, and divided attention) were administered. To assess behavioral elements of inattention, the primary caregiver completed the Behavior Rating Inventory of Executive Function (BRIEF) and the Conners' ADHD/DSM-IV Scale (CADS-P). The EP/ELBW group performed more poorly across all cognitive and behavioral measures than the FT/NBW group, with the exception of inhibition. The EP/ELBW group also had significantly elevated rates of impairment in selective, sustained, shifting and divided attention, as well as attention deficit hyperactivity disorder (ADHD) symptoms. No significant gender or gradient effects (e.g., <26 weeks' gestation vs. ≥ 26 weeks' gestation) were identified. Neonatal medical factors were not strong predictors of attention, although necrotizing enterocolitis (NEC) and cystic periventricular leukomalacia (PVL) were independent predictors of selective attention. In conclusion, our comprehensive assessment of attention provides strong evidence that children born EP/ELBW are at increased risk for attentional impairments, and as such, this population should be monitored closely during early and middle childhood with a focus on attention functioning.
Developmental Neuropsychology 01/2011; 36(1):57-73. · 2.56 Impact Factor
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ABSTRACT: School readiness is best understood as a framework for assessing profiles of strengths and vulnerabilities of the preschool-age child. Very preterm (VPT) children are at high risk of difficulties in school, and understanding their school readiness skills has the potential to aid successful transition into school. The aim of this study was to determine the school readiness skills of a cohort of VPT children, compared with term controls.
VPT children (gestational age <30 wk or birth weights <1250 g) and term controls were enrolled from a tertiary maternity hospital, Melbourne, Australia into a prospective cohort study. At age 5 years, school readiness skills were evaluated using a combination of parent questionnaires and direct assessments. The 5 domains of school readiness assessed were health and physical development, social-emotional skills, approaches to learning, communication skills, and cognitive skills.
VPT children had standard scores ~½ to 1 SD below those of the term controls in all domains of school readiness, and these differences were not greatly affected by adjustment for social risk differences. Overall, 44% of the VPT group had vulnerabilities in more than 1 domain of school readiness, compared with only 16% of the term controls.
VPT children are more likely than term controls to have significant vulnerabilities in multiple domains of school readiness, and these differences are mostly independent of social risk.
Journal of developmental and behavioral pediatrics: JDBP 12/2010; 32(2):117-24. · 2.27 Impact Factor
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ABSTRACT: The aim of the study was to examine the prevalence of developmental coordination disorder (DCD) at the age of 8 years in a geographic cohort of extremely preterm or extremely-low-birthweight (EP/ELBW) children and a term-born comparison group, as well as associated academic outcomes, parents' perceptions of motor performance, and changes in prevalence during the 1990s.
Moderate DCD was defined as a score below the 5th centile on the Movement Assessment Battery for Children in children without cerebral palsy or intellectual impairment. DCD rates were compared in a group of 132 8-year-old children born in 1997 at 22 to 27 weeks' gestation or birthweight of less than 1000 g (49% male, 51% female) and a comparison group of 154 term-born children (55% male, 45% female). The Wechsler Intelligence Scale for Children - 4th edition and the Wide Range Achievement Test - 3rd edition were used to measure academic and cognitive outcomes. Parental perceptions of motor performance were measured using the physical function scale of the Child Health Questionnaire, parent-report form (CHQ PF50). The results for children with and without DCD were then compared. To assess changes in prevalence throughout the 1990s, DCD rates were compared with those found in children from the same region born in 1991 to 92.
The mean number of completed weeks of gestation in the EP/ELBW children and in the comparison group of term-born children for whom data were available for analysis was 26.5 (SD 1.9) and 39.2 (SD 1.1) respectively, and the mean birthweight was 830 g (SD 163) and 3511 g (SD 462) respectively. The prevalence of DCD was 16% in the EP/ELBW group and 5% in the comparison group (odds ratio 3.45; 95% confidence interval [CI] 1.47-8.09%). Academic outcomes for reading, spelling, and arithmetic were poorer among children with DCD than among those without DCD (mean difference [95% CI] 10.2 [0.9-19.7; p=0.03], 8.9 [2.2-15.5; p=0.01], and 7.9 [1.4-14.5; p=0.02] respectively). Parental perceptions were poorly predictive of DCD.
EP/ELBW children have higher rates of DCD and experience more academic difficulties than term-born children. As parental perceptions are not a reliable screen, clinical assessments of motor skills in this vulnerable population are important.
Developmental Medicine & Child Neurology 10/2010; 53(1):55-60. · 2.92 Impact Factor
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ABSTRACT: To assess the ability of the third edition of the Bayley Scales of Infant and Toddler Development (Bayley-III) to detect developmental delay in 2-year-old children who were extremely preterm and those carried to term.
Prospective cohort study.
The state of Victoria, Australia.
Subjects were consecutive surviving children who were born either at less than 28 weeks' gestational age (extremely preterm) or with less than 1000 g birth weight (extremely low-birth-weight; n = 221) in the state of Victoria, Australia, in 2005 and randomly selected controls who were both carried to term and of normal birth weight (n = 220).
Children were assessed by psychologists blinded to knowledge of group at 2 years of age, corrected for prematurity with the new Bayley-III scale.
Follow-up rates of both cohorts were high (>92%). Mean values for all composite and subtest scores for the extremely preterm/extremely low-birth-weight group were significantly below those of the control group (P < .001), with the magnitude of all group differences being in excess of two-thirds SD. Mean values for the extremely preterm/extremely low-birth-weight group approached the normative mean, but in contrast, the mean values for the control group were higher than expected, with composite scores being between 0.55 and 1.23 SD above the normative mean. Proportions of children with developmental delay were grossly underestimated using the reference values, but were within the expected range when computed relative to the mean (standard deviation) for the controls.
The Bayley-III scale seriously underestimates developmental delay in 2-year-old Australian children.
Archives of pediatrics & adolescent medicine 04/2010; 164(4):352-6. · 3.73 Impact Factor
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ABSTRACT: Studies reporting the developmental outcomes for very preterm (VPT) children often focus on development at age 2 years. The aim of this study was to assess the stability of the rates of diagnosis of developmental disability from age 2 to 8 years in a regional cohort of VPT and extremely low-birth weight (ELBW) children and compare these with term controls.
VPT (22-27 completed weeks of gestation) and ELBW (birth weight 500-999 g) children and matched term controls born in Victoria, Australia, in 1997 were enrolled at birth in a regional prospective longitudinal study. Outcomes were assessed at ages 2 and 8 years.
Of the 283 VPT/ELBW live births, 71% survived to age 8 years and 94% were assessed. Of the 199 controls, 100% survived to age 8 years and 86.9% were assessed. At age 2 years, the rates of nil, mild, moderate and severe disabilities in the VPT/ELBW children were respectively 51.9%, 20.9%, 13.4% and 13.9%; and at age 8 years, 43.9%, 36.9%, 10.7% and 8.6%. The Cohen κ statistic revealed poor agreement between disability status at ages 2 and 8 years for VPT/ELBW children (0.20, p<0.001) but a higher level of agreement (0.37, p<0.001) for the control children. This was primarily driven by differences in classification of cognitive disability between ages 2 and 8 years.
Developmental outcomes at age 2 years are only a moderate predictor of long-term outcome and are not a reliable end point for follow-up studies of VPT and ELBW children.
Archives of Disease in Childhood 10/2009; 95(10):786-90. · 2.88 Impact Factor
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ABSTRACT: The survival rate for children born with gestational ages 22-27 weeks is increasing, and this may be associated with higher rates of disability. The aims of this study were to determine the outcomes at age eight for a regional cohort of children born at 22-27 weeks during 1997, and to compare their rates of disability with a cohort of the same gestational age born in 1991-1992.
Consecutive children with gestational ages in the range 22-27 weeks born in the state of Victoria, Australia, in 1997 and matched term controls were assessed at 8 years. Outcomes included blindness, deafness, cerebral palsy (CP) and intellectual impairment and disabilities caused by these impairments. These outcomes were compared with a cohort of 22-27-week and term children born in 1991-1992 in the same region.
Follow-up rates for the 1997 cohort at 8 years of age were 95% (144/151) for 22-27 weeks survivors and 89% (173/195) for controls. Rates of disability were substantially higher in the preterm cohort than the controls. The 1997 and 1991-1992 preterm cohorts had similar rates of moderate or severe disability (19%), however the rate of mild impairment was greater in 1997 (40% vs 24%). Rates of disability were almost identical in control groups. Intellectual impairment and CP were the major reasons for the higher rates of disability.
The high prevalence of adverse neurodevelopmental outcome in children born at 22-27 weeks compared with term controls at school age persists, and may even be increasing over time.
Archives of Disease in Childhood - Fetal and Neonatal Edition 10/2009; 95(2):F90-4. · 3.05 Impact Factor
