Catch-up growth during childhood among very low-birth-weight children.

OBJECTIVES: To examine growth attainment and correlates of catch-up growth at 8 years of age in a cohort of very low-birth-weight (VLBW) children (< 1500 g), including appropriate and small-for-gestational-age children, and to compare their growth with normal-birth-weight (NBW) children. DESIGN: Eight-year longitudinal follow-up of a cohort of VLBW children. A geographically based, randomly selected sample of NBW children was recruited at 8 years of age. SETTING: Tertiary perinatal center. PARTICIPANTS: Two hundred forty-nine VLBW children born between January 1, 1977, and December 31, 1979 (78% of survivors), of whom 199 were born appropriate for gestational age and 50 were small for gestational age (< -2 SD). The NBW population included 363 children. MAIN OUTCOME MEASURES: For the VLBW population, rates of subnormal weight (below the third percentile) and height were obtained at birth, at 40 weeks (term), and at 8 and 20 months. For the VLBW and NBW populations, mean weight, height, and percentile distribution at 8 years were derived from the National Center for Health Statistics standards. RESULTS: Catch-up growth to above the third percentile occurred between 40 weeks and 8 months, 8 and 20 months, and up to 8 years of age among the VLBW children. At 40 weeks, 54% were subnormal in weight and 60% were subnormal in height; at 8 months, 33% and 22%, respectively, and at 8 years, 8% were subnormal in weight and height. Small-for-gestational-age children had lower rates of catch-up growth. Multivariate analyses disclosed maternal height, race, birth weight, and neurologic abnormality to predict percentile distribution of height; and maternal height, small for gestational age, and neurologic abnormality to predict subnormal height. CONCLUSIONS: Catch-up growth occurs during childhood among VLBW children. These results have implications when counseling parents about the potential growth attainment of their children.

Transitions in cognitive status among the aged in Japan.

This study examines the competing risk of cognitive impairment, mortality and study attrition over a three year period within a national probability sample of Japanese elderly (n = 1506). Younger age and fewer chronic conditions were related to recovery, while older age, being married, poorer self-rated health and depression were related to mortality. Impaired, urban respondents were more likely to drop out of the study than impaired rural respondents. For those 'intact' at baseline, the probabilities of impairment, death and non-response were 7, 6 and 16%. Older, less educated individuals were more likely to become impaired; older males, less educated, married, those in poorer self-rated health with poor functional health were more likely to die; and younger, single, urban living individuals with poor self-rated and functional health, a past smoking history and high levels of depression were the most likely to drop out of the study. A Japanese elder aged 65 is expected to spend about 14.6 years (81%) free from cognitive impairement and about 3.45 years (19%) experiencing some degree of cognitive impairment throughout the remaining lifetime.

Hospitalization as a measure of morbidity among very low birth weight infants with chronic lung disease.

OBJECTIVE: To examine the spectrum of hospitalization and rehospitalization among very low birth weight (VLBW, <1500 gm) infants with severe chronic lung disease during the first 2 years of life. POPULATION: All 124 VLBW infants admitted to our center from October 1988 to September 1990 who were oxygen and ventilator dependent at 21 days of age. One hundred infants survived to discharge, of whom two subsequently died. The 98 surviving infants are the subject of this report. METHODS: The duration of the neonatal stay, the use of a long-term care facility, and rehospitalizations were recorded to a postnatal age of 24 months. The duration of these hospitalizations and the total duration of hospitalization during the first year of life were correlated with demographic and perinatal risk factors and 20-month outcome. RESULTS: The 98 infants spent a median of 125 days (range, 44 to 365) of their first year hospitalized; the neonatal stay accounted for 85% of this time. Forty-nine of the infants (50%) were rehospitalized in their first year (median stay, 14 days), and 36 (37%) were rehospitalized in their second year (median stay, 7 days). Long-term care facility stay and rehospitalizations accounted for 6% and 9% of the first-year hospitalizations, respectively. A median of 9 days (range, 1 to 365) of the second year of life were spent in hospital. The infants rehospitalized during their first year of life did not differ significantly from those not requiring rehospitalization with regard to maternal demographic descriptors, birth data, severity of chronic lung disease, or measures of 20-month outcome. Both duration of neonatal stay and total hospital stay during the first year were significantly associated with all measures of chronic lung disease severity and with 20-month neurodevelopmental outcome measures, whereas the duration of rehospitalization was associated only with duration of oxygen dependence. CONCLUSION: Among infants with severe chronic lung disease, the total duration of hospitalization during the first year of life provides a better index of morbidity than the number or duration of rehospitalizations alone.

Social class differences in social support among older adults.

The purpose of this study is to test for social class differences in social support among older adults. Data on a comprehensive range of social support measures provided by a nationwide sample of elderly people suggests that social class differences emerge when measures of contact with friends, support provided to others, and satisfaction with support are examined. However, significant differences fail to emerge with indicators of contact with family, support received from others, and negative interaction.

Twenty-month outcome in ventilator-dependent, very low birth weight infants born during the early years of dexamethasone therapy.

We sought to examine the effect of the introduction of dexamethasone therapy on health, growth, and neurodevelopmental outcome in very low birth weight (VLBW) infants at 20 months of age. We compared outcomes in all 86 VLBW infants (mean birth weight 871 gm, mean gestational age 26.4 weeks) who were ventilator dependent on day 21 of life during the 2 years preceding October 1988 (period 1), when dexamethasone therapy became accepted clinical practice in our unit, with outcomes in all 124 infants (mean birth weight 891 gm, mean gestational age 26.9 weeks) with similar ventilator status during the subsequent 2 years (period 2). In addition, we compared outcomes in infants who received dexamethasone during period 2 with those in a concurrent cohort of less ill infants who were not given dexamethasone. There were no significant differences between periods 1 and 2 in mortality rates after 21 days (17% vs 21%), need for home oxygen (23% vs 25%), oxygen dependence at 20 months of corrected age (11% vs 10%), rate of neurosensory impairment (24% vs 25%), and mean Bayley Mental scores (81.5 vs 77.2) or Psychomotor Development Index (81.6 vs 71.1). Infants who received dexamethasone during period 2 had significantly more severe lung disease and poorer respiratory, growth, and developmental outcomes. We conclude that VLBW infants with ventilator-dependent chronic lung disease have very poor outcomes, even when treated with dexamethasone. More information is needed from prospective, randomized trials before dexamethasone can be accepted as routine therapy for chronic lung disease.

Pneumopericardium in very low birth weight infants.

The objective of this study was to describe the incidence, neonatal correlates, and outcome of pneumopericardium (PPC) in very low birth weight (VLBW) < or = 1.5 kg infants. Forty-seven VLBW infants with a PPC, born during 1977 to 1989, were compared with a cohort of 1302 ventilated VLBW infants. PPC developed in 2% of 2389 VLBW infants and 3.5% of 1349 ventilated infants. The mean birth weight (1008 +/- 220 gm), and mean gestation (27 +/- 2 weeks) of the PPC cohort was similar to the control cohort. Thirty-two (68%) of the infants with PPC were male, compared with 691 (53%) of the ventilated infants (p < 0.05). Eight (17%) of the infants with PPC survived, compared with 780 (60%) of the control cohort (p < 0.00001). The oxygenation index significantly increased before PPC, and was significantly higher in nonsurvivors than survivors. Four (50%) of the PPC survivors had neurodevelopmental impairment at 20 months, compared with 35% of the control cohort. Pneumopericardium is a rare event with high morbidity and mortality. Clinicians should suspect this diagnosis in VLBW infants with a rising oxygenation index and subsequent acute deterioration.

Health of very low birth weight children during their first eight years.

To determine the impact of very low birth weight (VLBW) on medical outcomes during childhood, we compared the health of 249 VLBW children born from 1977 through 1979 with that of 363 normal birth weight (NBW) control children at 8 years of age. Measures included the rates of specific illnesses, surgical procedures and accidents, growth, and other physical findings. The number of medical conditions and surgical procedures was significantly greater in the VLBW children than in the NBW control children. Eighteen percent of VLBW versus 5% of NBW children had had respiratory conditions (p < 0.001), mainly before 3 years of age. Surgical procedures were more common both before and after 3 years of age, but accidents occurred with similar frequency. The VLBW children had significantly lower weight, height, and head circumference and more minor physical stigmata. Thus medical illness, surgical interventions, and poor growth attainment are part of the ongoing morbidity of VLBW children during childhood.

The effect of very low birth weight and social risk on neurocognitive abilities at school age.

We tested the hypothesis that very low birth weight (VLBW < 1.5 kg) children would have significantly poorer neurocognitive abilities at school age than would normal birth weight full-term age mates, that differences would persist after control for neurologic impairment and social risk, and that VLBW would interact with social risk. Two hundred forty-nine VLBW children and a randomly selected sample of 363 normal birth weight age mates born 1977 through 1979 were tested at 8 years. A neurologic examination and tests of intelligence, language, speech, reading, mathematics, spelling, visual and fine motor abilities, and behavior were performed. Twenty-four (10%) VLBW had a major neurologic abnormality compared with none of the controls. VLBW had significantly poorer scores on all tests, with the exception of speech and the total behavior score. These differences persisted among VLBW children without major neurologic abnormality, with the exception of social competence, reading, and spelling. Even normal IQ, neurologically normal VLBW had significantly poorer scores than did controls in expressive language, memory, visuomotor, and fine motor function, and measures of hyperactivity. When social risk was controlled in multiple regression analyses, VLBW still had an adverse effect on all outcome measures with the exception of speech. Social risk was, however, the major determinant of outcome. We found an interaction between VLBW and social risk only in verbal IQ and in the opposite direction than hypothesized.

Very-low-birthweight children and speech and language development.

Very low birthweight (VLBW) is often considered to be a risk factor for speech and language disorders, yet data are equivocal. The present study compared speech and language comprehension and production between 249 very-low-birthweight (VLBW: less than 1.5 kg) and 363 normal-birthweight 8-year-olds, randomly sampled in a geographic area. Mean performance for the entire group of VLBW children and for the group when 24 VLBW children with major neurologic abnormalities were excluded, was significantly lower than for controls on the majority of speech and language measures. Further analyses addressed the clinical significance of these statistically significant differences. Test scores were converted to standard scores and grouped according to standard deviation intervals, thus portraying each child's performance in terms of the magnitude of discrepancy from each test's mean. When the 24 children with major neurological abnormalities were excluded, no significant differences between the VLBW and control children were observed. Using discrepancy between WISC-R performance IQ and language to define specific language impairment (SLI), a higher percentage of control than VLBW children were identified as having SLI. Neonatal risk factors did not differentiate between VLBW children with or without SLI. A higher proportion of VLBW than control children did present subnormal language associated with IQ less than 85, hearing deficits, and/or major neurological impairments. Thus, SLI is not more common among VLBW than control children. Language deficits accompanied by more general developmental problems, however, are more frequent.