Comparing two motor assessment tools to evaluate neurobehavioral intervention effects in infants with very low birth weight at 1 year.

BACKGROUND: Infants with very low birth weight (VLBW) are at increased risk for motor deficits, which may be reduced by early intervention programs. For detection of motor deficits and to monitor intervention, different assessment tools are available. It is important to choose tools that are sensitive to evaluate the efficacy of intervention on motor outcome. OBJECTIVE: The purpose of this study was to compare the Alberta Infant Motor Scale (AIMS) and the Psychomotor Developmental Index (PDI) of the Bayley Scales of Infant Development-Dutch Second Edition (BSID-II-NL) in their ability to evaluate effects of an early intervention, provided by pediatric physical therapists, on motor development in infants with VLBW at 12 months corrected age (CA). DESIGN: This was a secondary study in which data collected from a randomized controlled trial (RCT) were used. METHODS: At 12 months CA, 116 of 176 infants with VLBW participating in an RCT on the effect of the Infant Behavioral Assessment and Intervention Program were assessed with both the AIMS and the PDI. Intervention effects on the AIMS and PDI were compared. RESULTS: Corrected for baseline differences, significant intervention effects were found for AIMS and PDI scores. The highest effect size was for the AIMS subscale sit. A significant reduction of abnormal motor development in the intervention group was found only with the AIMS. LIMITATIONS: No Dutch norms are available for the AIMS. CONCLUSIONS: The responsiveness of the AIMS to detect intervention effects was better than that of the PDI. Therefore, caution is recommended in monitoring infants with VLBW only with the PDI, and the use of both the AIMS and the Bayley Scales of Infant Development is advised when evaluating intervention effects on motor development at 12 months CA.

Prediction of cognitive abilities at the age of 5 years using developmental follow-up assessments at the age of 2 and 3 years in very preterm children.

AIM: This study investigated prediction of separate cognitive abilities at the age of 5 years by cognitive development at the ages of both 2 and 3 years, and the agreement between these measurements, in very preterm children. METHODS: Preterm children (n=102; 44 males; 58 females) with a gestational age less than 30 weeks and/or birthweight less than 1000g were assessed at the ages of 2 and 3 years using the second edition of the Bayley Scales of Infant Development, the Child Behaviour Checklist, and a neurological examination, and at the age of 5 years using the third edition of the Wechsler Preschool and Primary Scale of Intelligence. RESULTS: Cognitive development at ages 2 and 3 years explained 44% and 57% respectively of full-scale intelligence at the age of 5 years. Adding psychomotor, neurological, and behavioural outcomes to the regression model could not or only marginally improve the prediction; adding perinatal and sociodemographic characteristics to the regression model increased the explained variance to 57% and 64% respectively. These percentages were comparable for verbal intelligence. Processing speed quotient and especially performance intelligence were predicted less accurately. INTERPRETATION: Not all aspects of intelligence are predicted sufficiently by the Mental Development Index at ages 2 and 3 years. Follow-up of very preterm children until at least the age of 5 years is needed to distinguish between different aspects of cognitive development.

Neurodevelopmental outcome of post-hemorrhagic ventricular dilatation at 12 and 24 months corrected age with high-threshold therapy.

BACKGROUND: The management of post-hemorrhagic hydrocephalus remains a discussion. We describe the neurodevelopmental outcome at the corrected age of 12 and 24 months of infants with PHVD treated with high-threshold therapy. OBJECTIVE: To describe, and compare the neurodevelopmental outcome of a cohort of premature infants with grade III or IV intraventricular hemorrhage with or without development of PHVD. METHODS: Retrospective chart and image review of all IVH grade III and IV infants admitted to the department of Neonatology of the Academic Medical Center, Amsterdam, the Netherlands between January 1999 and December 2006. A standardized neurodevelopmental examination was performed at the corrected ages of 12 and 24 months. RESULTS: In total, 118 cases with IVH were identified. IVH grade III: n = 63, mean gestational age (GA): 28 weeks (SD 2.3), median birth weight (BW): 1130 g (range 908-1460 g); IVH IV: n = 31, mean GA: 28 weeks (SD 2.4), median BW: 1105 g (range 925-1230 g). Grade III and IV cases developed PHVD in 75% versus 42% respectively. Abnormal outcome in IVH III patients mainly occurred in cases with PHVD (12 months: 47% abnormal, 24 months: 64% abnormal). In the IVH IV cases, outcome was comparable with or without PHVD. Developmental delay was more pronounced at 24 months. CONCLUSION: Mainly IVH III cases developed PHVD. Comparing our results with the literature neurodevelopmental outcome was poorer with our high-threshold therapy.

Improvement of developmental outcome between 24 and 36 months corrected age in very preterm infants.

AIM: To study early developmental course in preschool-aged very preterm infants and its association with perinatal risk factors and test-taking behaviour. METHODS: Children born <30 weeks gestation and/or <1000g in the Academic Medical Center of Amsterdam were assessed at 24 and 36 months corrected age with the Dutch Bayley Scales of Infant Development-II (BSID-II-NL) and neurological examination. Linear regression analyses for developmental change were performed with perinatal risk factors. RESULTS: One hundred and forty-six children, mean GA 28 weeks and mean birth weight 1043 g, participated. Mental and psychomotor scores improved significantly with 6 and 7 points, respectively, from 24 to 36 months (p < 0.01). Mild to severe problems on at least one domain occurred less often at 36 (32%) compared to 24 months (63%) (p < 0.01), using corrected scores. Mental improvement was associated with being born very small for gestational age or <28 weeks; psychomotor improvement was associated with not being treated with indomethacin. Difficult test behaviour occurred mostly at 24 months and was associated with non-optimal development at 36 months. CONCLUSION: Improved developmental outcome and test behaviour were found at 36 compared to 24 months in a cohort of very preterm children. Long-term outcome studies and retesting of behaviourally difficult children are recommended.

The Infant Behavioral Assessment and Intervention Program for very low birth weight infants at 6 months corrected age.

OBJECTIVE: To determine whether the Infant Behavioral Assessment and Intervention Program (IBAIP), designed to support and enhance infants' self-regulatory competence, improved developmental and neurobehavioral outcomes in very low birth weight (VLBW) infants. STUDY DESIGN: We randomized 86 infants to 1 intervention before discharge and to 6 to 8 home interventions until 6 months corrected age, and 90 control infants received standard care. Developmental and behavioral outcomes were evaluated at 6 months corrected age with the Bayley Scales of Infant Development-II (BSID-II). Neurobehavioral functioning was evaluated with the Infant Behavioral Assessment (IBA) at baseline and at 6 months corrected age. RESULTS: Despite randomization, some differences in neonatal characteristics were found between the intervention and control infants. After adjustment, intervention effects of 7.2 points (+/- standard error 3.1) on the Mental Developmental Index and 6.4 +/- 2.4 points on the Psychomotor Developmental Index favored the intervention infants. The Behavioral Rating Scale of the BSID-II (P = .000) and the IBA (more approach [P = .003] and less stress [P = .001] over time) also favored the intervention infants. CONCLUSIONS: The IBAIP improved the mental, motor, and behavioral outcomes of VLBW infants at 6 months corrected age.

A randomised controlled trial comparing two temporising management strategies, one with and one without plasma volume expansion, for severe and early onset pre-eclampsia.

OBJECTIVES: Plasma volume expansion may benefit both mother and child in the temporising management of severe and early onset hypertensive disorders of pregnancy. DESIGN: Randomised clinical trial. Setting Two university hospitals in Amsterdam, The Netherlands. POPULATION: Two hundred and sixteen patients with a gestational age between 24 and 34 completed weeks with severe pre-eclampsia, haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome or severe fetal growth restriction (FGR) with pregnancy-induced hypertension, admitted between 1 April 2000 and 31 May 2003. METHODS: One hundred and eleven patients were randomly allocated to the treatment group, (plasma volume expansion and a diastolic BP target of 85-95 mmHg) and 105 to the control group (intravenous fluid restriction and BP target of 95-105 mmHg). MAIN OUTCOME MEASURES: Neonatal neurological development at term age (Prechtl score), perinatal death, neonatal morbidity and maternal morbidity. RESULTS: Baseline characteristics were comparable between groups. The median gestational age was 30 weeks. In the treatment group, patients received higher amounts of intravenous fluids (median 813 mL/day vs 14 mL/day; P < 0.001) with a concomitant decreased haemoglobin count (median -0.6 vs-0.2 mmol/L; P < 0.001). Neither neurological scores nor composite neonatal morbidity differed. A trend towards less prolongation of pregnancy (median 7.4 vs 11.5 days; P= 0.054) and more infants requiring oxygen treatment >21% (66 vs 46; P= 0.09) in the treatment group was observed. There was no difference in major maternal morbidity (total 11%), but there were more caesarean sections in the treatment group (98%vs 90%; P < 0.05). CONCLUSION: The addition of plasma volume expansion in temporising treatment does not improve maternal or fetal outcome in women with early preterm hypertensive complications of pregnancy.

Neurodevelopmental outcome of children treated with antenatal thyrotropin-releasing hormone.

OBJECTIVE: To evaluate neurodevelopmental outcome until 2 years of age in children who participated in a multicenter antenatal thyrotropin-releasing hormone (TRH) trial to improve respiratory outcome and to lower mortality. METHODS: Neurodevelopmental outcome was studied in infants whose mothers were admitted to the Academic Medical Center and enrolled in the European Antenatal TRH trial. Mothers were treated for imminent preterm delivery (before 30 weeks) with corticosteroids plus either placebo (placebo-group) or TRH (TRH-group). TRH treatment consisted of 400 micro g every 8 hours up to 4 doses. Assessments included neurologic development at 12 months and psychomotor development at 12 and 24 months using the Bayley developmental scales. RESULTS: Sixty-two infants were included, 10 of whom died. Of the surviving infants, 24 received TRH and 28 received placebo. Ten infants were lost to follow-up. Each group consisted of 21 infants. Both groups were comparable regarding gestational age, birth weight, and time interval between trial medication and birth. However, in the TRH group, more respiratory problems, ventilator days, and chronic lung disease were found. Neurologic and motor outcome did not differ between the groups, but lower mental developmental index scores were found in the TRH group at both ages. CONCLUSIONS: Antenatal TRH treatment is associated with a delay in mental development. This study demonstrates the importance of long-term follow-up of perinatal intervention trials with possible consequences for neurodevelopmental outcome of the infant.

Genetic influences in respiratory distress syndrome: a twin study.

This is a twin study of the contribution of genetic influences on the pathogenesis of respiratory distress syndrome (RDS). Retrospectively, the files of twins born between 1976 and 1995 in the Academic Medical Centre (before Wilhelmina Gasthuis) of the University of Amsterdam were studied with a gestational age of 30 to 34 weeks and 1 or both with RDS. Data were collected on gestational age, birth weight, Apgar score, or diabetes in the mother as risk factors. All children were born vaginally. One hundred ninety-four pairs of twins were born with a gestational age of 30 to 34 weeks. Twenty-six pairs were excluded, because neither of the babies developed RDS. Of the 168 pairs, we were able to determine zygosity in 80 pairs, of which 18 were monozygotic and 62 were dizygotic twins. This is a normal ratio for the gestational age of 30 to 34 weeks. Risk factors as formulated above were not different between the monozygotic and dizygotic twins. RDS occurred more frequently in both twins when the twins were monozygotic (12 of 18, 67%) than when the twins were dizygotic (18 of 62, 29%). This difference was statistically significant, P < .05 by Chi square analysis. When only 1 twin developed RDS, it was the second born in 4 (67%) of the other 6 pairs of monozygotic twins and in 34 (77%) of the 44 dizygotic twins (77%). This twin study supports the notion of a genetic contribution to RDS.