Fitness limitations in non-disabled extremely low birthweight adolescents.

AIM: This study aims to compare non-disabled otherwise healthy extremely low birthweight (ELBW) (<1000 g) children and term-born peers in an investigation of relationship between cardiorespiratory endurance and parent report of competence. METHODS: Forty-eight of 105 eligible ELBW 11- to 13-year-old children (27 male) and 55 term-born school peers (28 male) completed a 20-m shuttle run, anthropometric measures, respiratory function tests and the Motor Assessment Battery for Children. Parents completed the Child Behavior Checklist (CBCL). RESULTS: The ELBW group had poorer cardiorespiratory endurance (P = 0.002), growth (P = 0.002), respiratory function (P = 0.003) and motor ability (P < 0.001) than term-born peers. Parents reported the ELBW children to be less competent than term-born peers: CBCL total T score mean difference -9, 95% confidence interval -14, -5 (P < 0.001). Cardiorespiratory endurance predicted competence (regression coefficient 0.865; 95% confidence interval 0.352, 1.378; P = 0.001) independent of prematurity, growth, respiratory function, motor score, gender and socio-economic status. Cardiorespiratory endurance had association with social competence for all participating children, but was related to CBCL Activities Competence only for the ELBW children who were the significantly less fit group. CONCLUSIONS: The poor cardiorespiratory endurance prevalent in non-disabled otherwise healthy ELBW children is associated with general competence independent of prematurity and of the impact of other mild physical deficits, gender or socio-economic status. The relationship demonstrated between cardiorespiratory endurance and competence to engage in general activities of daily living, seen only in the less fit ELBW children, identifies the fitness levels in non-disabled ELBW children as a barrier to participation.

Perinatal events and motor performance of children born with ELBW and nondisabled.

PURPOSE: To explore the relationship between perinatal variables and motor performance in children who were born with extremely low birth weight (ELBW) and were nondisabled at 1 and 4 years. METHODS: Children without neurological or cognitive impairment (n = 48) born weighing less than 1000 g between 1992 and 1994 were assessed at 1 and 4 years corrected age using the Neurosensory Motor Developmental Assessment (NSMDA). Scores were used to categorize motor performance as normal or abnormal. RESULTS: Chronic lung disease (CLD) of prematurity, necrotizing enterocolitis (NEC), and patent ductus arteriosus were associated with NSMDA category at 1 year. Chronic lung disease, male gender, and NEC were associated with NSMDA category at 4 years. Multiple regression analyses revealed that CLD and NEC were independently associated with abnormal motor outcomes at 1 year. CONCLUSIONS: Early assessment and motor therapy is recommended for infants with CLD, because of its effect on motor performance in this otherwise healthy group of children born with ELBW.

Perinatal factors in non-disabled ELBW school children and later performance.

AIM: To determine the association between perinatal events and subsequent motor performance, cardiorespiratory endurance and respiratory function in non-disabled extremely low birthweight (ELBW) school children at 12 years of age. METHODS: Forty-eight ELBW infants were included in this study. The Movement Assessment Battery for Children (MABC), VO(2) max score as a measure of cardiorespiratory endurance and respiratory function testing were performed and perinatal variables were extracted from the children's hospital files. Children with MABC score ≤ 15th centile were described as having suspect motor performance. Children were classified as being unfit with a VO(2) max > 1 standard deviation below the mean according to gender and age. Perinatal risk factors were explored as risk factors for motor outcome, cardiorespiratory endurance and respiratory function. RESULTS: MABC category was significantly related with gender (P = 0.005) and chronic neonatal lung disease (P = 0.013). Multiple regression analysis showed motor outcome at 12 years to be independently related to male gender (P = 0.03) and chronic neonatal lung disease (P = 0.045). Sixty-five percent of all the children were identified as unfit. Chronic neonatal lung disease was significantly related to cardiorespiratory endurance (P = 0.03) and predicted VO(2) max at 12 years (P = 0.05). No perinatal factors were significantly related to respiratory function variables. CONCLUSION: Male gender and chronic neonatal lung disease were associated with later motor outcome of ELBW school children. It is suggested that objective and consistent follow-up from childhood through preadolescence are important to address motor and fitness issues especially for male children born with ELBW.

The long-term predictive validity of early motor development in "apparently normal" ELBW survivors.

BACKGROUND: Within the able majority of ELBW survivors, there is a lack of identified predictors of which children will require extra support despite having escaped significant disability. AIMS: Investigate the predictive validity of early motor scores, compared to that of perinatal descriptors or early growth, on long-term motor impairment in non-disabled ELBW (<1000g) children. STUDY DESIGN: Prospective longitudinal study. OUTCOME MEASURES: 48 non-disabled ELBW children (27 male) completed the Neurosensory Motor Developmental Assessment (NSMDA) at 8 months, 2 years and 4 years post term and The Motor Assessment Battery for Children (MABC) at 11-13 years of age. Other possible predictors of long-term outcomes (gestational age, birthweight, multiple birth, head circumference measures and gender) were retrieved from the records. RESULTS: Early motor assessment (NSMDA score) independently predicted the MABC total score at 11-13 years of age with a positive predictive value of 87% by 4 years post term. There was increased risk of long-term motor impairment associated with male gender but the degree of prematurity, multiple birth status or early growth measures did not predict motor outcome. Postural control and sensory motor scores at 4 years post term, rather than neurological score, were associated with long-term motor outcomes for the ELBW children at 11-13 years of age. CONCLUSIONS: Early motor scores are valid markers of long-term motor outcomes for "apparently normal" ELBW children. Early postural competence and sensory motor function are discriminating in regards to long-term motor function in neurologically normal ELBW children.

Neurodevelopmental outcome and risk factors for disability for twin-twin transfusion syndrome treated with laser surgery.

OBJECTIVE: This study was performed to report the neurodevelopmental outcome of survivors of twin-twin transfusion syndrome (TTTS) treated with laser surgery and to determine the risk factors for neurodevelopmental disability. STUDY DESIGN: A prospective study of TTTS cases treated with laser was performed. Survivors were assessed at 2 years corrected for prematurity. Neurodevelopmental disability was defined as the presence of cerebral palsy, deafness, blindness, or cognitive impairment with a developmental score >2 SDs below the mean. RESULTS: A total of 75 TTTS pregnancies were treated with a perinatal survival rate of 79.3%. A total of 113 survivors were assessed. The rate of cerebral palsy was 4.4% and cognitive impairment was 8%, with a neurodevelopmental disability rate of 12.4%. Quintero stage was the only independent risk factor for neurodevelopmental disability. CONCLUSION: The incidence of neurodevelopmental disability in TTTS survivors treated with laser is considerable, with Quintero stage being an independent risk factor.

Motor coordination difficulties and physical fitness of extremely-low-birthweight children.

Motor coordination difficulties and poor fitness exist in the extremely low birthweight (ELBW) population. This study investigated the relative impact of motor coordination on the fitness of ELBW children aged 11 to 13 years. One hundred and nine children were recruited to the study: 54 ELBW participants (mean age at assessment 12y 6mo; 31 male, 23 female; mean birthweight 769g, SD 148g; mean gestational age 26.6 weeks, SD 2.1 weeks) and 55 comparison children (mean age at assessment 12y 5mo; 28 males, 27 females; at least 37 weeks' gestation). All children completed the Movement Assessment Battery for Children (MABC), functional tests of postural stability and strength, growth measures, and tests of respiratory function. Maximal oxygen uptake (VO(2)max) was calculated from a 20m shuttle run test as a measure of fitness. The ELBW group had greater problems with postural stability (p=0.001) and motor coordination (p=0.001), with 70% rated as having a definite motor problem on the MABC brackets (those who scored less than the 5(th) centile on the MABC). The ELBW was also less fit than the comparison group (p=0.001), with 45% below the 10th centile for VO(2)max. There were differences between the groups for growth, strength, and particularly respiratory function. However, respiratory function did not significantly correlate with VO(2)max in the ELBW group. Motor coordination was the most powerful predictor of VO(2)max in both the ELBW (p=0.001) and the comparison groups (p=0.001).

Behaviour and quality of life at school age of children who had bronchopulmonary dysplasia.

BACKGROUND: There is little information available concerning behavioural and functional health problems in children who had bronchopulmonary dysplasia (BPD). AIM: To compare behavioural problems and quality of life in a cohort of children at school age who had BPD with preterm and term controls. METHODS: The cohort of 78 BPD children of 26 to 33 weeks' gestation was matched for birth weight with preterm controls. At school age follow-up, information was available for 66 BPD children and 60 preterm controls. (Three children with severe cerebral palsy were excluded). Parents completed the Child Behaviour Checklist (CBCL) and the Child Health Questionnaire (CHQ). The child's teacher completed the Teacher Report Form (TRF) of the CBCL, with the teachers of the BPD children completing a TRF on a classroom control. Parents completed a questionnaire on their levels of anxiety and depression. RESULTS: The mean total problem score on the CBCL for the BPD children was similar to the controls, with the BPD children displaying more internalising behaviours. Little variation was seen between the BPD and preterm children on the TRF. Significant differences between classroom controls and the BPD children were found for the total problem scores (p=0.001), internalising behaviours (p=0.01) and social (p=0.047), attention (p=0.0001) and thought problems (0.047). Results from the CHQ showed no difference between the groups in their physical health or the impact of health problems on family life. CONCLUSION: BPD children at school age display more internalising behaviour than preterm controls, with marked differences on comparison with classroom controls. Quality of life, however, does not seem to be adversely affected compared to the preterm controls.

Selection pressure-driven evolution of the Epstein-Barr virus-encoded oncogene LMP1 in virus isolates from Southeast Asia.

The geographically constrained distribution of Epstein-Barr virus (EBV)-associated nasopharyngeal carcinoma (NPC) in southeast Asian populations suggests that both viral and host genetics may influence disease risk. Although susceptibility loci have been mapped within the human genome, the role of viral genetics in the focal distribution of NPC remains an enigma. Here we report a molecular phylogenetic analysis of an NPC-associated viral oncogene, LMP1, in a large panel of EBV isolates from southeast Asia and from Papua New Guinea, Africa, and Australia, regions of the world where NPC is and is not endemic, respectively. This analysis revealed that LMP1 sequences show a distinct geographic structure, indicating that the southeast Asian isolates have evolved as a lineage distinct from those of Papua New Guinea, African, and Australian isolates. Furthermore, a likelihood ratio test revealed that the C termini of the LMP1 sequences of the southeast Asian lineage are under significant positive selection pressure, particularly at some sites within the C-terminal activator regions. We also present evidence that although the N terminus and transmembrane region of LMP1 have undergone recombination, the C-terminal region of the gene has evolved without any history of recombination. Based on these observations, we speculate that selection pressure may be driving the LMP1 sequences in virus isolates from southeast Asia towards a more malignant phenotype, thereby influencing the endemic distribution of NPC in this region.