Prediction of Bayley and Stanford-Binet scores with a group of very low birthweight children.

AIM: To study the prediction of cognitive development with a group of very low birthweight infants (<1500 g) at 18 months and at 4 years of age. METHODS: Bayley Scales of Infant Development-II Mental Development Indexes (MDI), and Stanford-Binet Intelligence Scale (S-B) Composite Scores were studied in a population of 334 children with birthweights <1500 g. Independent variables measured were gestational age, birthweight, gender and parental socio-economic status (SES). RESULTS: Longer gestation (28 weeks and over) and higher birthweight (1000-1500 g) proved to be advantageous for cognitive ability at both 18 months and 4 years. Other significant advantages were associated with female and higher SES. High correlations were found between MDI and the S-B Composite Score (r = 0.62), and between birthweight and gestation (r = 0.72). When information available at birth was included in forward stepwise regression analyses to predict the S-B Composite at 4 years, the best predictors were MDI at 18 months and SES. CONCLUSION: With the measures employed and this population, prediction of cognitive development from early childhood to preschool was possible. This may enable reliable identification of those children at risk for delayed cognitive development who require intervention before starting school.

Follow up of a randomised trial of two different courses of dexamethasone for preterm babies at risk of chronic lung disease.

OBJECTIVES: To report 18 month outcome of a randomised trial of two courses of dexamethasone to prevent chronic lung disease of prematurity. STUDY DESIGN: Babies of birth weight 1250 g or less ventilated at 7 days of age were randomised to a 42 day reducing course (long) or a 3 day pulsed (pulse) course of dexamethasone. Growth, cardiovascular status, and respiratory and neurodevelopmental outcomes were assessed at 18 months. RESULTS: Seventy six babies were enrolled. Nine died and three were lost to follow up. Babies receiving the long course were weaned off oxygen more quickly than those receiving the pulse course (47% v 69% on oxygen at 28 days; p = 0.01), but there were no differences in 18 month outcomes. However, children averaged -1 SD for growth parameters, half had moderate or severe disability, and 35% and 19% respectively required oxygen at 36 weeks and discharge. CONCLUSIONS: The dexamethasone course used did not influence long term outcome. However, entry criteria for this study selected a group of babies at high risk of poor long term outcome.

Neurodevelopmental outcome of infants treated with head cooling and mild hypothermia after perinatal asphyxia.

OBJECTIVES: To determine the neurodevelopmental outcome of infants treated with head cooling with systemic hypothermia after hypoxic-ischemic encephalopathy. STUDY DESIGN: Infants >/=37 weeks' gestation, who had an umbilical artery pH

Some influences on cognitive development in a group of very low birthweight infants at four years.

AIM: To report the findings of an audit of 91 < 1,500 grams birthweight children at four years of age and consider the cognitive and behavioural results in the light of gestation, birthweight and socio-economic status. METHOD: Children born in 1993 were assessed using the Stanford-Binet Intelligence Scale, Conners' Parent Rating Scales and clinical evaluation. Parent interview provided further information on development, health and behaviour. RESULTS: Significant differences were demonstrated in a number of comparisons. For the Stanford-Binet results, children >28 weeks gestation obtained higher mean scores than those of shorter gestation for Abstract Visual Reasoning (representing cognitive skills such as spatial perception and visual - motor coordination), and Quantitative Reasoning (which includes numerical ability). In the case of birthweight, the mean score for children > or = 1,000 grams was higher on Quantitative Reasoning than that obtained by the lower birthweight group. When socioeconomic status classification was introduced, a number of differences in test scores were apparent, with children whose parents were in the lowest classification consistently performing less well. Quality of language results followed the same pattern. Analysis of the Conners' Scales identified this low socio-economic status group as having more learning problems and higher scores on the Hyperactivity Index than those whose parents were in the highest socioeconomic status group. CONCLUSION: Results for cognitive performance on the Stanford-Binet Scale were within one standard deviation of the mean, for the study population as a group. However, findings suggested that children <1,000 grams birthweight, or <28 weeks gestation, and those <1,500 grams with parents in the lowest socio-economic group, were at particular risk of achieving lower scores prior to school entry. Their pattern of cognitive ability and behaviour could inhibit their adjustment to formal education when complex concepts require problem solving at a more advanced level.

Developmental outcome at 18 months of children less than 1000 grams.

AIMS: Aims of this paper were to carry out an audit of 105 extremely low birth weight infants at 18 months of age, identifying problems, disseminating the resulting information and providing a basis for future work. METHODS: Children born in 1990-2 were classified in categories I to IV according to outcome, and selected perinatal variables were analysed for these groupings. RESULTS: The disability rate (categories I and II) within this cohort was 21% a similar finding to that reported in other literature. For the group with slow motor development and/or tonal abnormalities the percentage was 15. Despite the high risk nature of this group 64% of children were progressing well (category IV) at this age. No significant differences in outcome were found between small for gestational age and appropriate weight for gestational age infants. Significant results were demonstrated in the adverse effects of chronic lung disease and intraventricular haemorrhage on subsequent development. CONCLUSION: The information obtained from this study provides support for the use of this type of audit in Units with extremely low birth weight populations.

Cognitive development and behaviour in very low birthweight twins at four years.

This study included two groups of 37 children, one of twins and the other singletons at 4 years of age. All subjects has birthweights under 1500 grams and individuals in the groups were matched for birth date, gender and birthweight. Except when parental socio-economic status was taken into account, no significant differences between twins and singletons were observed on any of the results of The Stanford-Binet Intelligence Scale, nor were there any when the twins and singletons were divided into groups with birthweights < 1000 grams and 1000 to 1499 grams. When cognitive scores were analysed in relation to socio-economic status, there were significant differences in the whole population between subjects in the high and low socioeconomic status groups, with higher mean scores for the former. Comparison of the twins and singletons with parents in the lower socio-economic status group did not produce any significant differences but in the case of the upper socio-economic status group the singletons scored significantly better than the twins in Quantitative Reasoning and on the Composite Score. No significant differences were demonstrated in the clinical assessment of speech, language or behaviour. So far as general life considerations and health were concerned only one significant difference was found and this was for the number of siblings born subsequently, with more born in the singleton families. This study did not provide support for the view that singletons and twins differ significantly in the areas considered.

A case of agammaglobulinaemia complicated by meningoencephalitis due to Echo virus 27.

A boy with agammaglobulinaemia diagnosed and treated from the age of 3 years 2 months developed encephalitis at 4 years 3 months. The illness showed a remitting but deteriorating course until death aged 6 years 5 months. Echo virus type 27 was isolated from the cerebrospinal fluid during the terminal illness. The virus was not isolated from five earlier cerebrospinal fluid samples nor was virus detected in a temporal lobe biopsy.

School progress and cognitive development of 6-year-old children whose mothers were treated antenatally with betamethasone.

The cognitive development of children whose mothers had been included in the first Auckland trials of betamethasone therapy in premature labor were studied. An earlier study of these children used psychometric tests during the fifth year of life. In the present study tests were given during the seventh year of life (the second year of school) to 250 (82.2%) of 304 surviving children. Of the 250 children, 139 were in the group whose mothers had received betamethasone and 111 were in the control group. Further tests of cognitive development were made, together with assessment of the children's progress in school. Again, on the majority of measures there were no significant differences between children whose mothers had received betamethasone and the children in the control group. Calculations of statistical power showed that important differences were unlikely to have been missed.

Cognitive and psychosocial development of 4-year-old children whose mothers were treated antenatally with betamethasone.

The present study was part of a larger study investigating the long-term development of children of mothers included in a controlled trial of betamethasone therapy in preterm labor, the purpose was to determine whether there are any benefits or hazards of treatment detectable up to the seventh year of life. The first 318 children of mothers included in the trial because of spontaneous premature labor were selected for study. Of 305 survivors, 258 (84.6%) were included in this phase of the study. Detailed tests of psychological development, together with assessments of psychosocial background, were made during the fifth year. Of the 258 children 144 were in the betamethasone group and 114 were control patients. Despite a heavy weighting of the betamethasone group with more prematurely delivered infants and more boys (resulting from improved perinatal survival of these children associated with betamethasone therapy), no significant differences emerged between the groups in measures of outcome. It was concluded that betamethasone therapy, under the conditions of the original trial, was not hazardous to cognitive development as measured in this study.