Long-term neurodevelopmental outcome in preterm infants with intraventricular haemorrhage.

BACKGROUND: Intraventricular haemorrhage (IVH) is one of the key risks for long-term neurodevelopmental issues. There remains controversy over the impact low-grade IVH has on the long-term outcome of premature infants. This study describes the long-term neurodevelopmental impact of Grade I and II IVH in former preterm infants in the early school years. METHODS: This is a retrospective cohort analysis from one tertiary neonatal intensive care unit (NICU) in Australia including all infants born at <30 weeks' gestation and admitted to the NICU between 2006 and 2013 with complete ultrasound reports and follow-up results. Results of standardised tests for neurodevelopmental outcomes at 5 and 8 years were compared between infants who suffered mild IVH and infants who had normal head ultrasounds. RESULTS: During the study period, 491 infants <30 weeks gestation were admitted; 275 patients had full follow-up data available. We found no significant difference in examined outcomes at 5- and 8-year follow-up. CONCLUSION: Mild IVH does not affect cognitive, motor and academic outcomes at school age.

Predicting the outcome of specific language impairment at five years of age through early developmental assessment in preterm infants.

BACKGROUND: Very preterm infants (<30 weeks of gestation) are at increased risk of specific language impairment and systematic developmental follow-up is essential for the provision of targeted early intervention. AIMS: To define the predictive value of early language testing and stability of language development, and perinatal and demographic risk factors for the diagnosis of SLI at 5 years, in a cohort of preterm infants. STUDY DESIGN: We used a retrospective hospital based cohort study. SUBJECTS: Preterm infants <30 weeks of gestation, were cared for in NICU at RPAH, between 2004 and 2007, and prospectively enrolled in developmental follow-up. Standardised developmental assessment was done at 3 years utilising the Bayley Scales of Infant and Toddler Development-III and the Wechsler Preschool and Primary Scale of Intelligence-III was done at 5 years. OUTCOME MEASURES: Predictive value and stability of early language testing were assessed with respect to SLI at 5 years, using measures of diagnostic accuracy and kappa values. Multivariate logistic regression was performed during the distribution of perinatal and demographic risk factors for SLI. RESULTS: One-in-five met diagnostic criteria for SLI (19%, n=24). Limited diagnostic accuracy was found with early expressive language and the stability of language scores demonstrated only fair agreement (Cohen's κ .383). Multilingual status and extreme gestational age at 24-25 weeks were associated with a six-fold increased risk of SLI (OR 6.09, 95% CI 1.89-19.56; OR 6.09, 95% CI 1.28-29.0). CONCLUSION: We defined a high incidence of SLI among our cohort, but only a limited diagnostic accuracy of early language testing. Multilingual status and extreme prematurity were independent risk factors for SLI. It remains imperative to perform continued developmental assessments beyond pre-school age to identify language impairment with greater accuracy.

Motor impairment and low achievement in very preterm children at eight years of age.

AIM: To examine the concurrence of motor impairment and academic underachievement in a group of very preterm children at 8 years of age. METHODS: All surviving children with a gestational age less than 30 weeks, admitted to the neonatal intensive care unit between 1987 and 1997, were prospectively enrolled in developmental follow-up. Children with a neurosensory disability or a low intelligence score (FSIQ < or = 75 points) were excluded. At 8 years of age the Bruininks Oseretsky Test of Motor Proficiency and standardised tests of academic achievement were administered to a sample of 323 very preterm children. RESULTS: One hundred and one (31.3%) of these very preterm children were identified as having Developmental Coordination Disorder (DCD). Of the children with DCD, 54.4% also had underachievement in literacy and/or numeracy. As the severity of motor impairment increased so too did the severity and complexity of underachievement. Significantly fewer children with motor impairments participated in after-school sporting activities. Children with DCD required more mechanical ventilation support during their hospital admission. CONCLUSIONS: This study demonstrated that a significant proportion of children born very preterm find both motor and academic skills difficult in early school years.

Implementation and evaluation of an individualized developmental care program in a neonatal intensive care unit.

PURPOSE: This study aims to detect differences in outcomes for very preterm infants after the introduction of developmental care in a neonatal nursery, and to evaluate the effect of developmental care on parental well-being. DESIGN AND METHODS: Prospective before and after cohort study of very preterm babies, with education for all staff between cohorts. RESULTS: No significant differences were found between cohorts for short-term outcomes for babies or parental anxiety levels or depression. All infants scored within normal temperament ranges at 4 months. PRACTICE IMPLICATIONS: Developmental care is a safe practice model. The interdisciplinary study facilitated professional development and increased the knowledge of nurses.

Phonology, rapid naming and academic achievement in very preterm children at eight years of age.

AIM: To examine the impact and additive effect of phonology and rapid naming deficits on reading, spelling and mathematics achievement in a group of very preterm children at 8 years of age. METHODS: All surviving children with a gestational age less than 30 weeks, admitted to the neonatal intensive care unit at Royal Prince Alfred Hospital, in 1994 and 1995, were prospectively enrolled in developmental follow-up. Children with a neurosensory disability or a low intelligence score (FSIQ

Educational and therapeutic resource dependency at early school-age in children who were born very preterm.

AIM: To examine the incidence of educational and therapeutic resource dependency in a group of very preterm children at 8 years of age. METHODS: All children with a gestational age less than 30 weeks, who survived to discharge from the neonatal intensive care unit at Royal Prince Alfred Hospital, between 1987 and 1994, were prospectively enrolled in developmental follow-up. At 8 years of age, information regarding resource dependency was obtained from parents and teachers using interviews and questionnaires. Standardized psychometric measures of cognition and academic achievement were administered. RESULTS: Information was obtained for 365 (73.3%) of surviving 8-year-old children; 65 (17.8%) had a neurosensory disability and 24 (36.9%) children in this group were in full-time special education. In those without neurosensory disability (n=300), seven (2.3%) children were already in full-time special education for an intellectual deficit. Among children in mainstream education, 154/293 (52.5%) had received or were still receiving additional assistance in some form (part-time special education, grade retention, therapeutic intervention or private tutoring). Difficulty in literacy was the most commonly reported problem. Resource dependency was not related to gestation nor predicted by intelligence in children without neurosensory disability, but was related to maternal education. Children who had had or were continuing to receive part-time assistance showed delays in academic skills at assessment. CONCLUSIONS: A high level of on-going resource dependency exists in this group in an attempt to maintain grade appropriate achievement. Resource dependency is not related to gestation in neurologically normal children. General cognitive measures of intelligence do not predict these problems in the majority of children.