Neurodevelopmental Outcome of the Premature Infant
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.
[Show abstract] [Hide abstract] ABSTRACT: Objectives: To investigate cognition, social adaptive functioning, behavior, and emotional development in the preschool period and to determine the effects of the age of onset of walking on those developmental areas in children who were born preterm without major neurodevelopmental impairments (NDI) early in life. Methods: Fifty-eight children who were born preterm without major NDI early in life participated in this study. The Korean versions of the Wechsler Preschool and Primary Scale of Intelligence or the Bayley Scales of Infant Development, the social maturity scale, the Korean version of the Child Behavior Checklist (CBCL), Conners' abbreviated parent/teacher rating scale, the Childhood Autism Rating Scale, and a speech developmental test were administered. The participants were divided into two groups: early walkers (group A) and late walkers (group B). Results: The full-scale intelligence quotient (IQ) and performance IQ were significantly lower in group B than in group A, while the verbal IQ did not differ significantly between the groups. The children in group B had greater risks of cognitive deficits than did the children in group A, especially in performance skills. The social quotient (SQ) was significantly lower in group B than in group A (p<0.05). The rates of mild or significant deficits based on SQ and the CBCL did not differ significantly between the groups. Four children in group A and one child in group B had attention/hyperactivity problems. One child in group A had autistic behavior. Only one child in group B showed a significant speech developmental delay. Conclusions: Problems in cognition, social adaptive functioning, and emotional and behavioral development can occur in children without major NDI early in life. Late walkers had significantly lower scores in cognition and social adaptive functioning than did early walkers.0Comments 0Citations
- "Infants born preterm are at greater risk of developing motor, cognitive, language, and behavioral impairments compared with infants born at term [1,2]. Thus, many previous studies have investigated neurodevelopmental outcomes in infants born preterm. "
- "The long-term cognitive, behavioral, and social sequelae of CHD are well documented, and the AHA and the AAP recommend systematic , routine ND follow-up of children with CHD (Marino et al., 2012 ). Developmental follow-up programs have long been standard of care in patient populations known to be at high risk for ND impairments, such as infants born prematurely and children with cancer (Mulhern & Butler, 2006; Ramey et al., 1992; Stephens & Vohr, 2009 ). Identification of need and facilitating access to resources in the context of high-risk pediatric populations is essential to maximizing developmental success. "
[Show abstract] [Hide abstract] 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.0Comments 5Citations
- "Intelligence quotient (IQ) is most commonly used to assess neurodevelopmental outcomes in school-aged children born VLBW. Though mean IQ scores of children born VLBW have been shown to be up to 10 points below those of matched full-term peers , most fall within the average range when major disabilities are excluded456. 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  including working memory, inhibitory control, and cognitive flexibility91011. "