Predicting neurodevelopmental impairment in preterm infants by standardized neurological assessments at 6 and 12 months corrected age.

AIM: Neurodevelopmental impairment in very preterm infants can be reasonably diagnosed by 18-24 months corrected age, whereas the predictive value of earlier assessments is debated. We hypothesized that neurological findings at 6 and 12 months indicative of subsequent cerebral palsy predict 18-24 months' neurodevelopmental impairment. METHODS: Neurodevelopmental examinations (Griffiths scales) at 20 months of age in 561 preterm infants (birth weight <1 500 g) were compared with results of standardized neurological examinations (Early Motor Pattern Profile; EMPP) and Griffiths scales at 6 (n = 451) and 12 months (n = 496) corrected age. RESULTS: Griffiths developmental quotients at 20 months were weakly but significantly related to EMPP scores at 6 (R(s) = 0.328) and 12 months (R(s) = 0.493). Areas under receiver operator characteristic curves for the EMPP to predict neurodevelopmental impairment (Griffiths scores

Neurodevelopment at 1 year of age in infants with congenital heart disease.

OBJECTIVE: To assess psychomotor development and neurological sequelae in infants after surgery for congenital heart defects. DESIGN AND SETTING: Single institution prospective cohort study. PATIENTS: 90 of 112 consecutive surviving infants of less than 1 year of age, without brain anomalies, conditions, or syndromes associated with delayed mental development, who underwent cardiac surgery during an 18 month period; 20 control infants with minor or no congenital heart defects. MAIN OUTCOME MEASURES: Griffiths developmental scales and standardised neurological examination at 1 year. RESULTS: Mean (SD) developmental quotient (DQ) in index infants was 99 (10.6), compared with 106.7 (6.6) in controls (p < 0.001). DQ was lower in infants after palliative surgery (n = 16; 88 (12.2)) than after corrective surgery (n = 74; 101.4 (8.6)) (p < 0.001). Of the 90 index infants, 24 (27%) had a DQ below 93.5 (more than 2 SD below the mean of controls). Developmental delay (DQ < 93.5) was more common after palliative surgery (10/16, 63%) than after corrective surgery (14/74, 19%) (p < 0.001). Of the 90 index infants, 29 (32%) had neurological abnormalities, compared with only one of the 20 controls (5%) (p = 0.013). Neurological abnormalities were more frequent after palliative surgery (11/16, 69%) than after corrective surgery (18/74, 24%) (p < 0.001). CONCLUSIONS: There is a considerable rate of neurodevelopmental impairment at 1 year of age in infants after cardiac surgery. Psychomotor impairment and neurological sequelae are apparently more severe in infants in whom only palliative surgery is possible.

Early cessation of breast milk feeding in very low birthweight infants.

This investigation was carried out to comparatively assess the duration of breast milk feeding and to analyze risk factors for early cessation of breast milk feeding in term and very preterm infants. A cohort study was performed in 89 consecutive very low birthweight (VLBW) infants (<1500 g) who survived for at least for one week, and 177 term infants with birthweights >2500 g born in the same hospital matched for gender and multiplicity. Median duration of breast milk feeding, as determined from charts and questionnaires mailed to the mothers at 6 and 12 months corrected age, was 36 days in VLBW infants, compared to 112 days in control infants (P<0.0001). In both VLBW and control infants, smoking during pregnancy, low maternal and low paternal school education were each significantly associated with short duration of breast milk feeding. In VLBW infants, multiple pregnancy and gestational age <29 weeks were each associated with prolonged breast milk feeding, as were maternal age >35 years and spontaneous pregnancy (as opposed to pregnancy following infertility treatment) in term infants. Multivariate analysis revealed that VLBW, smoking and low parental school education were independent negative predictors of breast milk feeding. While these results emphasize the need for special support of VLBW infant mothers promoting lactation, the relationships between smoking, school education and breast milk feeding in both strata show that efforts to increase breast milk feeding require a public health perspective.

Growth and neurodevelopmental outcome of very low birthweight infants with necrotizing enterocolitis.

UNLABELLED: The aim of the study was to assess the effect of necrotizing enterocolitis (NEC) on neurodevelopmental outcome and growth. Neurodevelopmental outcome of 20 out of 22 suriviving very low birthweight infants (VLBW) diagnosed with NEC between 1992 and 1996 was compared with 40 control infants matched for gestational age and year of admission. Follow-up studies were performed at 12 and 20 mo of corrected age. The German revision of the Griffiths' scales was used for development assessment. Neurodevelopment was significantly delayed in infants with NEC at 12 mo (median general developmental quotient: 90.0 vs 97.8; p = 0.04) and 20 mo (86.4 vs 97.7; p = 0.004) of age. Somatic growth did not differ between infants with and without NEC. Fifty-five percent of infants suffering from NEC but only 22.5% of the infants without NEC were severely retarded (developmental quotient < -2 SD of a control group of healthy newborns) at 20 mo of corrected age. CONCLUSION: Preterm infants developing NEC are at risk for neurodevelopmental impairment and need close neurodevelopmental follow-up for the first years of life.

The CRIB (Clinical Risk Index for Babies) score and neurodevelopmental impairment at one year corrected age in very low birth weight infants.

OBJECTIVE: To assess the ability of the Clinical Risk Index for Babies (CRIB) to predict long-term neurodevelopmental impairment in very low birth weight (VLBW) infants. DESIGN: Single-center cohort study. SETTING: Tertiary neonatal care hospital and follow-up clinic. PATIENTS: Four hundred fifty-five VLBW infants consecutively admitted from 1992 to 1997 inclusive. MEASUREMENTS AND RESULTS: Calculations of CRIB scores from birth weight, gestational age, the presence of congenital malformations, worst base excess, maximum and minimum appropriate fraction of inspired oxygen (FIO2) during the first 12 h of life was possible in 430 infants. Three hundred eighty-six infants survived until discharge (89%) and 352 (91%) were examined at 1 year corrected age using the Griffiths scales of mental development. Major neurodevelopmental impairment (general quotient < 2 standard deviations below average) was observed in 76 infants (22%). CRIB scores and the individual CRIB components differed significantly between infants with and those without neurodevelopmental impairment. By logistic regression analysis, CRIB scores and minimum FIO2 were independent predictors of death, while CRIB and maximum FIO2 were independently associated with neurodevelopmental impairment. For combined poor outcome (death or impairment), CRIB, minimum and maximum FIO2 were independent predictors. In predicting major neurodevelopmental impairment, the area under the receiver operating characteristic curve for CRIB (0.703 +/- 0.035) did not differ significantly from that of birth weight (0.697 +/- 0.035) or any other CRIB component. CONCLUSION: While high CRIB scores are associated with major neurodevelopmental impairment, the CRIB score is of limited value for stratification in randomized trials or for adjustments in comparing performance between hospitals with neurodevelopmental impairment as the main outcome measure.

Parental and professional agreement in developmental assessment of very-low-birthweight and term infants.

The aim of this prospective follow-up study was to evaluate the accuracy of a parent-completed questionnaire compared with professionally detected developmental delay. Parents of 108 very-low-birthweight (VLBW) infants and parents of 279 term control infants completed the German version of the Revised Prescreening Developmental Questionnaire (R-PDQ) at the corrected age of 12 months. Simultaneously, infants underwent developmental examination using the Griffiths Developmental Scale. Sixty-nine VLBW infants were classified as not delayed, 16 as delayed by both methods (conegativity 76% and copositivity 94%), as compared to 240 and six term control infants (conegativity 88%, copositivity 94%). The questionnaire suggested delay in 22 VLBW infants and 32 control infants, which was not substantiated by professional examination (P=0.006). In contrast, examination-diagnosed delay was missed by the questionnaire in one infant in each group. The R-PDQ is a reliable monitoring instrument for both VLBW and term infants at the age of 12 months. Parents of VLBW infants tend to underestimate their infants' development.

Hearing in newborn infants of opiate-addicted mothers.

UNLABELLED: To investigate effects of maternal drug abuse on neonatal hearing, auditory brain-stem evoked potentials were recorded in 132 consecutive newborn infants of mothers who had taken heroin or methadone during pregnancy, alongside 1016 neonates with and 483 hospitalized neonates without risk factors, as defined by the Joint Committee on Infant Hearing. In infants antenatally exposed to opiates, the rate of severe bilateral hearing impairment (> or =50 dB) did not differ from that of hospitalized neonates without risk factors (1.5% vs. 2.5%). In contrast, intra-uterine toxoplasmosis, syphilis, or cytomegalovirus infection, bilirubin serum concentrations >25 mg/dl, craniofacial anomalies, and mechanical ventilation for 5 days or more were independently associated with increased rates of severe hearing impairment by analysis of all 1631 infants studied. CONCLUSION: Newborns of opiate-addicted mothers are not at increased risk for early onset hearing loss.

Late neurological sequelae of non-hemolytic hyperbilirubinemia of healthy term neonates.

Records of the only children's hospital equipped to perform exchange transfusions in West Berlin were used to identify all 29 non-hemolytic healthy term newborns with total serum bilirubin between 20 and 30 mg/dL, 16 of whom were available for follow-up neurological examination according to Touwen. Compared to 18 case controls with bilirubin <12 mg/dL, jaundiced children scored significantly worse only on the choreiform dyskinesia scale.

Neurodevelopmental outcome after prenatal exposure to opiates.

UNLABELLED: To study the developmental effects of prenatal exposure to opiates, a prospective follow up study of 34 drug-exposed (opiates and nicotine) and 42 reference infants (nicotine exposure only) was conducted from January 1992 to September 1995. At the time of delivery, 12 of 34 mothers used opiates without medical control. Twenty-two mothers participated in a methadone maintenance programme. At 1 year, the average Griffiths Developmental Quotient (DQ) was lower in the drug-exposed group (mean: 100.5 vs. references 107.9; P < 0.001). This difference was mainly due to lower subscales "locomotor" (mean 100.8 vs. 111.4; P < 0.05) and "intellectual performance" (mean 100.8 vs. 108.5; P < 0.05) in the drug-exposed group. Severe developmental retardation mean DQ (-2 SD) was diagnosed in 2 drug-exposed infants. Mild developmental retardation (mean DQ: 1 SD- > 2 SD) was found in 7 drug-exposed and in 3 reference infants (P < 0.05). Neurological abnormalities were found more frequently in the drug-exposed group (11 vs. 3 infants; P < 0.01). Among the opiate-exposed infants, the subscales "hearing and speech" and "intellectual performance" were lower in the uncontrolled drug-using than in the methadone group. The 17 fostered infants showed no difference in developmental outcome compared with the 10 infants living with their biological parents (mean DQ: 100.0 versus 101.3). CONCLUSIONS: At 1 year infants prenatally exposed to opiates are at risk for mild psychomotor developmental impairment.

Parents' estimation of psychomotor development in very low birthweight (VLBW) infants.

BACKGROUND: Within a longitudinal developmental surveillance project we tested the accuracy of the Revised Prescreening Developmental Questionnaire (R-PDQ) to detect developmental retardation in very low birthweight (VLBW) infants. METHODS: Seventy surviving VLBW-infants born between July 1992 and December 1993 were re-examined at 6 months corrected age. The parent-completed questionnaires (n = 67) were compared with developmental assessment using the Griffiths Developmental Scale. RESULTS: At 6 months corrected age, normal results of the Griffiths Developmental Scale (developmental quotient > or = 81) were found in 61/67 (91%) VLBW-infants and in 45/67 (67%) questionnaires (no or one 'delay'). The parents identified all six infants with psychomotor retardation on the Griffiths Developmental Scale (co-positivity 100%). However, only 45/61 infants with normal development were so identified with the R-PDQ (co-negativity 74%, positive predictive value 27%). CONCLUSIONS: The R-PDQ discovered all infants whose developmental quotient was two standard deviations below the mean on the Griffiths Developmental Scale. The relatively high proportion of false positive R-PDQ results corresponded to lower developmental quotients within the normal range. Therefore, the R-PDQ provides a useful screening instrument for VLBW-infants.

Autosomal-recessive neural crest syndrome with albinism, black lock, cell migration disorder of the neurocytes of the gut, and deafness: ABCD syndrome.

We report on a macrosomic newborn girl with albinism, a black lock at the right temporo-occipital region, and retinal depigmentation. Bilateral deafness was confirmed by brainstem auditory-evoked potentials. In addition, the infant had a severe defect of intestinal innervation. Biopsy showed aganglionosis of the large intestine, and total absence of neurocytes and nerve fibers in the small intestine, indicating a total lack of sympathetic and parasympathetic innervation. The infant died of intestinal dysfunction at 5 weeks. She was the 14th child of consanguineous Kurdish parents. Four sibs of our patient had the same syndrome and died a few days after birth. The other 9 sibs are well, with an unremarkable phenotype. A syndrome of albinism, black lock, deafness, and a total lack of intestinal neural innervation has not yet been reported. It represents a new neural crest syndrome with autosomal-recessive inheritance.

Normal auditory brain stem evoked responses in infants of diabetic mothers.

Auditory brain stem responses potentials were recorded from 71 newborns within the first 2 weeks after birth; conceptional age ranged from 37 to 41 weeks. Thirty-nine newborns were infants of diabetic mothers (IDMs) (17 White A, 22 White B-D) and 32 healthy term newborns served as control group. IDMs with additional high risk for cochlear or brain stem integrity were excluded. Birthweight for gestational age was significantly higher for IDMs. No differences in auditory brain stem responses wave latencies or amplitudes were observed between healthy infants of the control group and IDMs.

[Psychosocial components of illness in the child]. / Die psychosoziale Komponente der Krankheit des Kindes.

In 77 children aged 1 year the mother-child interaction in relation to the morbidity of the child was analysed. The following factors appeared to be correlated to the quality and quantity of the mother-child interaction: (i) the date of the first acute illness, (ii) the frequency of illness during the first year of life, (iii) the duration, frequency and seriousness of the illnesses after admission to day care at the age of one year. Conclusions are drawn for the practice of infant care.

[Microbial colonization of the upper respiratory tracts of day care children in relation to acute morbidity episodes]. / Die mikrobielle Besiedlung der oberen Atemwege von Krippenkindern in Abhängigkeit vom akuten Morbiditätsgeschehen.

The upper respiratory tracts of 20 children attending a crèche were studied for bacteria up to the 128th day of crèche attendance. To this end nose and throat swabs as well as double blood withdrawals were to determine antibodies against various respiratory viruses. The germ spectrum thus obtained was correlated with the acute pathological processes occurring during the period of investigation. In addition to the normal flora, the nasopharynx of infection-stable children was, with one exception, only populated with gram-positive pathopotent bacteria during the first four months of crèche attendance. In infection-labile children, however, gram-negative pathopotent bacteria, blastomycetes of the Candida group as well as Mycoplasma, virus and mixed infections were discovered apart from gram-positive bacteria. This broad germ spectrum should be taken into wider consideration in the chemotherapy of respiratory infections.

[Bacterial colonization of the nasopharynx in a comparison of home reared and day care children]. / Bakterielle Besiedelung des Nasen-Rachenraumes im Vergleich von Haus- und Krippenkindern.

Differences of the bacterial population of home- and daycared children are more significant within the nose than in the pharynx. In vitro the efficiency of erythromycine against bacteria of the nose-pharynx-area is broader then that of Penicilline and the combination Trimethoprime plus Sulfonamide.

[Acute illness following admission to child day care centers and the use of antimicrobial agents]. / Das akute Krankheitsgeschehen nach Krippenaufnahme und der Einsatz von Antimikrobiotika.

1. During the first six months after the admission to day-care acute infections of children are very frequent. This gives rise to the question for the justification of the indication of antibacterial chemotherapy during this period. 2. During the mentioned period all acute illnesses and the corresponding therapies of total 361 children in Berlin, the capital of the GDR, Leipzig and Schwedt are analysed. 3. The local differences of the appearance of the antibacterial chemotherapy are not caused by the type and frequency of the diagnosis, but reflect the inadequate consideration for the therapy recommendations given by the Society of Pädiatrics. 4. The correlations between antibacterial chemotherapy and the appearance of acute respiration illnesses (ARI) suggest the influence of the bacteria on the origin of these illnesses of day-cared children.

[Age and development related changes in counseling priorities for pediatric home visits]. / Alters- und entwicklungsabhängige Veränderungen von Beratungsschwerpunkten beim Hauskind.

More home visits should be made in the context of prophylactic care for children up to three years of age, in order to come to grips with problems of child development likely to results from the inadequate knowledge and experience of parents and to promote age-adjusted motivation for the undisturbed development of their children. In this sense home visits can be an effective approach to primary prevention and a contribution to harmonious development in childhood. The priorities of counselling and their content are subject to change, depending on the age and development of the children involved. Examples are given of age-adjusted stimulation of development for one-year-old children. They are based on results of empirical investigations conducted between 1984 and 1987.