Psychomotor development in very and extremely low-birth-weight preterm children: Could it be predicted by early motor milestones and perinatal complications?

Preterm-born children are at risk of slower psychomotor development. This risk may be associated with low birth weight and other perinatal factors and morbidities. We aimed to assess psychomotor development in school-aged preterm children, and to determine whether some early motor and perinatal variables could be related to and/or predict the later motor achievements. Parents of 54 very low-birth-weight preterm, 24 extremely low-birth-weight preterm and 96 control children completed the Movement Assessment Battery for Children (MABC-2-C) checklist and were interviewed about the motor milestones of their children. Significant differences were found between the preterm and control groups in the MABC-2-C results. MABC-2-C outcomes were significantly predicted by the age of crawling, the use of steroids, mechanical ventilation and intraventricular hemorrhage (IVH). The use of screening tools may allow the rapid identification of psychomotor development delays. The presence of some perinatal risk factors and some motor milestone attainments could be related to motor development in the later childhood of preterm children.

Valoración de los criterios diagnósticos de la enuresis nocturna / Assessment of nocturnal enuresis diagnostic criteria

Introducción: La enuresis nocturna (EN) es un trastorno frecuente que afecta tanto a los niños como a sus familias. El objetivo es determinar la prevalencia en una extensa muestra de niños considerando diferentes criterios diagnósticos. Pacientes y métodos: Estudio descriptivo transversal mediante encuesta a padres de niños asturianos seleccionados aleatoriamente entre los escolares de enseñanza primaria y secundaria (seis, 10 y 13 años). El cuestionario constaba de 80/55 preguntas para los que se orinasen o no en la cama, respectivamente; 10 fueron respondidas por los niños. Se registró la EN como primaria o secundaria y la presencia o no de enuresis como único síntoma. Además, comparamos la prevalencia según los diferentes criterios diagnósticos. Resultados: De los 3.548 cuestionarios distribuidos fueron respondidos correctamente el 56,6%. 102 escolares se orinaban en la cama (5,52%), lo que corresponde a una prevalencia del 2,82% según el DSM-IV-TR/5 y la ICCS, 3,7% con el DSM-III y CIE-10. Fue más frecuente en niños que en niñas (2,8:1), con gran predominio de las formas primarias (81,2%) y no monosintomáticas (68,66%). La resolución espontánea en el grupo de mayor edad es superior en niños que en niñas, igualándose a los 13 años las diferentes prevalencias de edades previas. Conclusiones: La prevalencia de la EN en nuestra región coincide con la observada en algunos estudios. Existen diferencias según los criterios utilizados, lo que debe llamar la atención sobre la necesidad de unificar la metodología de los estudios y los criterios utilizados en su diagnóstico. (AU)

Introduction: Nocturnal enuresis (NE) is a common disorder that affects both children and their families. The objective is to determine its prevalence in an extensive sample of children considering different diagnostic criteria. Patients and methods: Cross-sectional descriptive study using a survey of parents of a selection of primary and secondary school Asturian children (6, 10 and 13 years). The questionnaire consisted of 80 or 55 questions (10 of which were answered by the children) for those who urinated or not in bed, respectively. NE was registered as primary or secondary, and the presence or not of enuresis as the only symptom. In addition, the prevalence was compared according to the different diagnostic criteria. Results: Of the 3 548 questionnaires distributed, 56.6% were answered completed correctly. A total of 102 children urinated in bed (5.52%), which corresponds to a prevalence of 2.82% according to the DSM-IV-TR/5 and the (International Continence Society) ICS, 3.7% with the DSM-III and ICD-10. It was more frequent in boys than in girls (2.8:1), with a predominance of primary forms (81.2%), and non-monosymptomatic (68.66%). The spontaneous resolution in the older age group was higher in boys than in girls, with the different prevalences of previous ages being equal to 13 years. Conclusions: The prevalence of NE in the studied region coincides with that observed in some other studies. There are differences according to the criteria used, which should draw attention to the need to unify the methodology of the studies and the criteria used in its diagnosis. (AU)

Assessment of nocturnal enuresis diagnostic criteria.

INTRODUCTION: Nocturnal enuresis (NE) is a common disorder that affects both children and their families. The objective is to determine its prevalence in an extensive sample of children considering different diagnostic criteria. PATIENTS AND METHODS: Cross-sectional descriptive study using a survey of parents of a selection of primary and secondary school Asturian children (6, 10 and 13 years). The questionnaire consisted of 80 or 55 questions (10 of which were answered by the children) for those who urinated or not in bed, respectively. NE was registered as primary or secondary, and the presence or not of enuresis as the only symptom. In addition, the prevalence was compared according to the different diagnostic criteria. RESULTS: Of the 3548 questionnaires distributed, 56.6% were answered completed correctly. A total of 102 children urinated in bed (5.52%), which corresponds to a prevalence of 2.82% according to the DSM-IV-TR/5 and the (International Continence Society) ICC, 3.7% with the DSM-III and ICD-10. It was more frequent in boys than in girls (2.8:1), with a predominance of primary forms (81.2%), and non-monosymptomatic (68.66%). The spontaneous resolution in the older age group was higher in boys than in girls, with the different prevalences of previous ages being equal to 13 years. CONCLUSIONS: The prevalence of NE in the studied region coincides with that observed in some other studies. There are differences according to the criteria used, which should draw attention to the need to unify the methodology of the studies and the criteria used in its diagnosis.

The association between perinatal and neonatal variables and neuropsychological development in very and extremely low-birth-weight preterm children at the beginning of primary school.

Preterm children with very low birth weight (<1,500 g) and extremely low birth weight (<1,000 g) have an increased risk of experiencing neuropsychological delays. The purpose of this study is to characterize the neuropsychological profile of very and extremely low birth weight preterm children and discover what maternal conditions, diseases, procedures, and alterations in preterm newborns could be related to their later neuropsychological development. Eighty-nine preterm children (aged from 5 to 7 years) were assessed on their intelligence quotient (IQ), executive function, memory, and visuospatial memory in a single session, using the RIST and NEPSY-II test. Parents provided sociodemographic data. Preterm children showed lower scores than normative values on impulsivity, visual short-term memory, and spatial relation abilities. Extremely-low-birth weight preterm children also showed less inhibitory control and worse mental rotation skills. Neonatal surgical procedures, late-onset sepsis, and periventricular hemorrhages had the greatest impact on neurodevelopment. When one or more of these conditions are present, memory is the most affected neuropsychological function, followed by visuospatial skills, inhibitory control, and IQ. It is important to take into account the presence of maternal conditions, diseases, interventions, and neonatal alterations in preterm newborns in order to determine the risk of neuropsychological delays in later development.

Identificación de problemas de conducta y emocionales en niños prematuros en el ámbito de atención primaria / Identification of behavioural and emotional problems in premature children in the primary care setting

OBJETIVOS: Evidenciar la utilidad, para su uso por el pediatra de atención primaria, del cuestionario BASC (Behavior Assessment System for Children) para la detección precoz de los problemas psicológicos y comportamentales en los prematuros. DISEÑO: Estudio transversal y descriptivo. Emplazamiento: Centro de atención primaria (Área Sanitaria IV del Principado de Asturias) y centro hospitalario (Hospital Universitario Central de Asturias), España. PARTICIPANTES: Padres de 87 niños prematuros con peso menor de 1.500g al nacimiento y de 43 controles nacidos a término, ambos grupos con edad de 5 a 7 años. Mediciones principales: Se aplicó el cuestionario BASC (versión para padres). RESULTADOS: Los niños prematuros presentan diferencias respecto a los controles, muestran mayores niveles de inatención (Z = -4,125; p < 0,001), ansiedad (Z = -2,801; p = 0,005) e interiorización de conductas (Z = -2,148; p = 0,032), conductas que son más evidentes a los 5 años. Los niños prematuros presentan mayores niveles de hiperactividad (Z = -2,082; p = 0,037) y problemas de conducta (Z = -2.354; p = 0,019) que las niñas, que destacan en problemas de atención (Z = -2.345; p = 0,019). CONCLUSIONES: El BASC permite la detección y diagnóstico precoz en atención primaria de los problemas de conducta y emocionales de los niños prematuros

OBJECTIVE: To demonstrate the usefulness, for use by the primary care pediatrician, of the BASC questionnaire (Behavior Assessment System for Children) for the early detection of psychological and behavioral problems in premature infants. DESIGN: Cross-sectional and descriptive study. SETTING: Primary care (Health Area IV of the Principado of Asturias) and Hospital Universitario Central de Asturias, Spain. PARTICIPANTS: Parents of 87 premature children with birth weight less than 1500g and 43 full-term controls, both aged 5-7 years. MAIN MEASUREMENTS: The BASC questionnaire (parent version) was applied. RESULTS: Preterm children presented a high rate of inactivity (Z = -4.125, P < 0.001), anxiety (Z = -2.801, P = 0.005) and internalization problems (Z = -2.148, P = 0.032), being more evident at 5 years of age. Preterm boys show higher levels of hyperactivity (Z = -2.082, P = 0.037) and behavioural problems (Z = -2.354, P = 0.019) than girls, who presented more attentional problems (Z = -2.345; P = 0.019). CONCLUSIONS: The BASC questionnaire is useful for the detection and early diagnosis at the primary care level of the behavioral and emotional problems of premature children

Development of egocentric and allocentric spatial orientation abilities in children born preterm with very low birth weight.

BACKGROUND: Very low birth weight preterm infants show neuropsychological alterations in functions such as memory or visuospatial skills, although certain related functions, such as spatial orientation, have not been studied. OBJECTIVES: To compare children born preterm and at term between the ages of 5 and 7 years on egocentric and allocentric spatial orientation, and relate their performance to visuospatial skills, behavior, memory in daily environments, and perinatal risk factors. STUDY DESIGN: Observational cross-sectional study. SUBJECTS: 88 very low birth weight children born preterm and 59 controls. OUTCOME MEASURES: IQ (RIST), visuospatial skills (NEPSY II: Route Finding and Geometric Puzzles), spatial orientation (Egocentric and Allocentric Spatial Memory Test - Children's Version), behavior (BASC questionnaire for parents), memory in everyday environments (ECM-Q questionnaire for parents), and perinatal risk factors (collected from medical records). RESULTS: Children born preterm obtain significantly lower scores than controls on the RIST, Route Finding, and Allocentric Spatial Memory Tests. Although spatial orientation is related to other neuropsychological variables in both premature and control children, there is no meaningful association with behavior or daily memory in children born preterm. The perinatal risk factors that are associated the most with visuospatial and orientation problems are surgical procedures and peri- and intraventricular hemorrhages. CONCLUSIONS: Children born preterm with low birth weight present difficulties in their spatial orientation, and for this reason, we propose including these types of tasks in the usual neuropsychological evaluation.

[Identification of behavioural and emotional problems in premature children in the primary care setting]. / Identificación de problemas de conducta y emocionales en niños prematuros en el ámbito de atención primaria.

OBJECTIVE: To demonstrate the usefulness, for use by the primary care pediatrician, of the BASC questionnaire (Behavior Assessment System for Children) for the early detection of psychological and behavioral problems in premature infants. DESIGN: Cross-sectional and descriptive study. SETTING: Primary care (Health Area IV of the Principado of Asturias) and Hospital Universitario Central de Asturias, Spain. PARTICIPANTS: Parents of 87 premature children with birth weight less than 1500g and 43 full-term controls, both aged 5-7 years. MAIN MEASUREMENTS: The BASC questionnaire (parent version) was applied. RESULTS: Preterm children presented a high rate of inactivity (Z = -4.125, P < 0.001), anxiety (Z = -2.801, P = 0.005) and internalization problems (Z = -2.148, P = 0.032), being more evident at 5 years of age. Preterm boys show higher levels of hyperactivity (Z = -2.082, P = 0.037) and behavioural problems (Z = -2.354, P = 0.019) than girls, who presented more attentional problems (Z = -2.345; P = 0.019). CONCLUSIONS: The BASC questionnaire is useful for the detection and early diagnosis at the primary care level of the behavioral and emotional problems of premature children.

Calidad de vida de los padres de escolares nacidos prematuros con peso menor de 1.500 gramos / Quality of life of parents of school age children with a birth weight less than 1500 grams

Introducción: El nacimiento de un hijo prematuro conlleva un alto coste emocional familiar. El objetivo es valorar la calidad de vida de los progenitores de una cohorte de niños prematuros nacidos con peso menor de 1.500g, cuando estos contaban entre los 5 y los 7 años de edad. Pacientes y métodos: Estudio transversal de encuestas personales a progenitores de niños de entre 5 y 7 años de edad que estuvieron ingresados en un hospital terciario de España entre 2009 y 2011, siendo neonatos, por un peso al nacimiento menor de 1.500g. Se aplicó la escala del estrés parental, test de Apgar familiar, escala de sobrecarga del cuidador de Zarit y cuestionario Graffar. Se analizan 94 casos (40 niñas y 54 niños). Resultados: Todas las escalas muestran puntuaciones de normalidad. Con la escala de Zarit, del estrés parental y el cuestionario Graffar-Méndez Castellano, los resultados no reflejan diferencias por sexo, peso ni edad gestacional. Encontramos diferencias estadísticamente significativas con el test de Apgar familiar por sexo y entre la puntuación de Graffar y el grado de disfunción familiar. En el momento del estudio, los padres de niños con problemas en el desarrollo presentaban diferencias estadísticamente significativas con los padres de niños sin alteraciones, reflejadas en el test de Apgar familiar y en la escala de Zarit. Conclusión: La posible repercusión del nacimiento de un hijo con un peso menor de 1.500 g no se aprecia con los test estudiados cuando el niño tiene entre los 5 y 7 años de edad, salvo por las diferencias que se observan en la percepción de la funcionalidad familiar y en la sobrecarga de cuidadores entre los padres de niños con alteraciones en el desarrollo y sin ellas

Introduction: The birth of a preterm child has a high family emotional cost. The aim of this study is to assess the quality of life of parents of children aged 5-7 years born prematurely (<1500 g). Participants and methods: This is a cross-sectional study of a sample of parents of preterm infants admitted to a third level hospital in Spain between 2009 and 2011. Their infants weighed less than 1500 g at birth, and were 5-7 years old at the moment of the study. Parents completed the Parental Stress Scale, Family Apgar, Zarit modified scale, and Graffar-Méndez Castellano method (1994). A total of 94 cases were analysed (40 girls and 54 boys). Results: All data passed normality assumptions. Results showed no gender, weight or gestational age differences in our sample on the Zarit modified scale, Parental Stress Scale, or by the Graffar method. Differences between boys and girls were found in the Family Apgar test. Also, the Graffar method and degree of familiar malfunction showed significant results. The parents of preterm children with developmental problems at the time of the study showed significant differences with respect to parents of children without these problems in the Family Apgar test and the Zarit modified scale. Conclusions: The possible impact of the birth of a preterm child with less than 1500g of weight is not appreciated between 5 to 7 years of age, except for the differences found in the perception of family functionality and caregiver overload among parents of children with and without developmental alterations

[Quality of life of parents of school age children with a birth weight less than 1500 grams]. / Calidad de vida de los padres de escolares nacidos prematuros con peso menor de 1.500 gramos.

INTRODUCTION: The birth of a preterm child has a high family emotional cost. The aim of this study is to assess the quality of life of parents of children aged 5-7 years born prematurely (<1500g). PARTICIPANTS AND METHODS: This is a cross-sectional study of a sample of parents of preterm infants admitted to a third level hospital in Spain between 2009 and 2011. Their infants weighed less than 1500g at birth, and were 5-7 years old at the moment of the study. Parents completed the Parental Stress Scale, Family Apgar, Zarit modified scale, and Graffar-Méndez Castellano method (1994). A total of 94 cases were analysed (40 girls and 54 boys). RESULTS: All data passed normality assumptions. Results showed no gender, weight or gestational age differences in our sample on the Zarit modified scale, Parental Stress Scale, or by the Graffar method. Differences between boys and girls were found in the Family Apgar test. Also, the Graffar method and degree of familiar malfunction showed significant results. The parents of preterm children with developmental problems at the time of the study showed significant differences with respect to parents of children without these problems in the Family Apgar test and the Zarit modified scale. CONCLUSIONS: The possible impact of the birth of a preterm child with less than 1500g of weight is not appreciated between 5 to 7 years of age, except for the differences found in the perception of family functionality and caregiver overload among parents of children with and without developmental alterations.