Cognitive performance and attachment patterns at four years of age in extremely low birth weight infants after early intervention.

This study aims at assessing the effects of an early occupational therapy intervention on the cognitive development and the development of attachment patterns in ELBW infants. The intervention, given weekly at home from six months to 12 months, aimed at supporting parent-child interaction and enhancing motor control and coordination. The study population consisted of 100 ELBW infants matched in pairs in accordance to their pre-perinatal risk scores and allocated successively to intervention or non-intervention groups. Cognitive development was assessed with the Bayley Scales at age two and with the WPPSI at age four. Attachment to primary caregiver was assessed with the Preschool Assessment of Attachment (PAA). Cognitive performance was within age norms in both groups at both ages. Intervention did not show any effect on cognitive performance at the age of two years. At the age of four years, cognitive level was overall, and most notably for verbal performance, higher in the intervention group than in the control group. There was an over-representation of the so-called atypical attachment patterns (those not fitting the normative A, B, or C categories) in the control group. The results are discussed in terms of finding more global ways to support the development of at risk pre-term children.

Cognitive development, temperament and behavior at 2 years as indicative of language development at 4 years in pre-term infants.

This study focuses on the early temperamental (TTQ = toddler temperament questionnaire), behavioral (IBR = infant behavior record), and cognitive precursors of impaired language functioning in preschool-age pre-terms infants. The study group consisted of 63 pre-term infants with a mean birth weight of 1246 +/- 437 g born in 1989-1991 in the University Central Hospital of Helsinki. Children with major disabilities (CP or mental retardation) were excluded. At the age of 4 years, 22% showed impaired language function. Logistic regression analysis showed that the Bayley MDI score was the best predictor in identifying an increased risk for language impairment. Behavioral characteristics were more strongly associated with subsequent language impairment than temperament.

Neurological development up to the age of four years of extremely low birthweight infants born in Southern Finland in 1991-94.

A total of 142 infants with birthweights of less than 1000 g were examined at the age of 4 y by a child neurologist, by a neuropsychologist and by an occupational therapist in order to establish the rate of neurological disorders. A total of 57 (40%) of the children had normal neurological development, 52 (37%) had minor neurological disorders, 27 (19%) were diagnosed with cerebral palsy, and 6 (4%) were mentally retarded (IQ <71) with no motor disability. The rate of cerebral palsy was identical with the figure at age 2 y, but the rate of minor neurological disorders increased from 25% to 37%. Compared with international rates, we found a higher rate of cerebral palsy, but the incidence of minor neurological disorders corresponded with figures published previously.

Temperament profiles and their role in neurodevelopmental assessed preterm children at two years of age.

The aim of this study was to determine whether preterms (n = 80, mean birth weight 1,205 g) differ from full-terms (n = 80) in temperament profile at 24 months of age and to explore the relationship between temperament, neurodevelopment, and behavior. Temperament was assessed using the Toddler Temperament Questionnaire, which defines nine temperament dimensions: activity, rhythmicity, approach/withdrawal, adaptability, mood, intensity, distractability, persistence, and sensory threshold. Neurodevelopment was assessed by the Bayley Scales of Infant Development and by neuropediatric examination. Behavior was assessed using the Infant Behavior Record, which is a part of the Bayley Scales. When temperament was considered, the preterms were significantly less active, more adaptive, more positive in mood, less intense, and lower in threshold to respond than the controls. The results on IBR showed that preterms were significantly less goal directed, less attentive, and lower in endurance than the controls. The preterms performed significantly less well than the controls on the Bayley test. Low Bayley scores correlated with temperament scores of high rhythmicity, positive mood, low persistence, and high threshold and with IBR scores of poor social orientation, negative emotional tone, poor co-operation, short attention span, and poor endurance.

Health and development of children born after oocyte donation compared with that of those born after in-vitro fertilization, and parents' attitudes regarding secrecy.

The health, growth and development of a cohort of children (n = 59) aged 6 months to 4 years and born after oocyte donation (OD) was compared with that from a group of children born after in-vitro fertilization (IVF) (n = 126). The study was performed by questionnaire, and the response rate was 100% in the OD group and 95% in the IVF group. All OD children were healthy. Three IVF children had a neurological disorder. Surgical intervention had been carried out in 8% of the OD and 13% of the IVF children. Height and weight development were normal, and eating and sleeping disorders were uncommon in both groups of children. The IVF mothers more often expressed concern about the child's behaviour than did the OD mothers. Thirty-eight percent of the OD parents and 60% of the IVF parents intended to tell the child about the nature of its conception (P < 0.01). Although oocyte recipients appear to have more complications during their pregnancies than conventional IVF patients, the general health status of OD children aged <5 years is at least as good as that of IVF children. Growth and development in both groups of children is similar to that of the general population.

Neurodevelopment until the adjusted age of 2 years in extremely low birth weight infants after early intervention--a case-control study.

A total of 104 infants with birth weights of less than 1000 grams were enrolled in this prospective case-control study in order to examine the effect of occupational therapy based on sensory integration (SI) and neurodevelopmental therapy (NDT) on neurological development. The children were grouped as matched pairs on the basis of a set of developmental risks assessed at the age of 3 months. The intervention children had a weekly session of 60 minutes of occupational therapy from the corrected age of 6 months up to 12 months. All the children were examined at the corrected age of 3, 6, 9, 12, 18 and 24 months. The neurodevelopment of the cases and the controls did not differ essentially and the only significant difference was found in the social development of the children at the age of 12 months to the advantage of the intervention group. It is concluded that this amount of occupational therapy in at-risk children does not have a relevant effect on neurological development.

Randomized study of the effect of antenatal dexamethasone on growth and development of premature children at the corrected age of 2 years.

The objective of the series was to study the effect of prenatal dexamethasone therapy on the growth and neurological development of preterm children until the age of 2 years. Eighty-two children with a mean gestational age of 30 (24-33) weeks and a mean weight of 1291 (530-2360) g at birth, treated antenatally with either dexamethasone (n = 50) or placebo (n = 32), were examined at the adjusted age of 24 months by a paediatric neurologist, a neuropsychologist and a speech therapist. Neurological development was defined as normal if all scores of neuropaediatric, neuropsychological and verbal tests were within the normal range. Normal neurological development was found in 52% of the dexamethasone-treated and in 34% of the placebo-treated children. The incidence of cerebral palsy was 10% in the dexamethasone group and 22% in the placebo group. Minor developmental delay was found in 42% of dexamethasone-treated and in 53% of placebo-treated children. Our follow-up results indicate that the beneficial effect of prenatal glucocorticoid treatment on cerebral complications (intraventricular haemorrhage or periventricular leucomalacia) demonstrated during the neonatal period may be followed by a lower incidence of cerebral palsy in surviving premature children.

Event-related brain potential of human newborns to pitch change of an acoustic stimulus.

We report here event-related potentials (ERPs) of human newborns to occasional pitch changes in a repetitive sequence of tone pips. These pitch changes elicited a large slow negative ERP component which resembles the mismatch negativity (MMN) generated by the adult brain under similar conditions. This MMN-type of negativity in newborns suggests that already at this early ontogenetic stage the brain monitors the acoustic environment for a possible change in any of its repetitive aspects. Apart from its theoretical interest, this finding might provide a new way to test the development of the central nervous system and to diagnose cerebral dysfunction at a very early stage.