Respiratory health, lung function, and airway responsiveness in school-age survivors of very-low-birth-weight.

The purpose of this study was to determine the respiratory symptoms, pulmonary function, and airway reactivity in school-age survivors of very-low-birth-weight and to describe the influence of birth weight and perinatal illness on their pulmonary function. Thirty (of 39) 10- to 11-year-old survivors of very-low-birth-weight (VLBW) recruited at birth into a prospective longitudinal study of development; 30 (of 32) normal-birth-weight peers recruited from the same school or census tract as the VLBW group at age 5; and 15 normal-birth-weight siblings of the VLBW group participated in the study. Outcome measures were mother's reports of respiratory health; forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1); FEV1/FVC; forced expiratory flow, midexpiratory phase (FEF25-75); peak expiratory flow rate (PEFR); and tolerance to methacholine. There were no differences between groups in mothers' reports of current respiratory health. Pulmonary function values were lower for the VLBW survivors but significant only for FEF25-75 (F = 4.13; P = 0.02). Number of days in the intensive care nursery correlated significantly with decreased FEV1 (r = -.40, df = 28, P = 0.03), FEV1/FVC (r = -.37, df = 28, P = 0.04, and FEF25-75 (r = -.39, df = 28, P = 0.03). Only the relationship between length of nursery stay and FEV1/FVC was independent of birth weight. Number of days on mechanical ventilation was significantly correlated with decreased FEV1 (-.44, df = 28, P = 0.01), FEV1/FVC (r = -.38, df = 28, P = 0.04), FEF25-75 (r = -.44, df = 28, P = 0.01, and PEFR (r = -.40, df = 28, P = 0.03). All of these relationships were independent of birth weight. There were no significant associations between perinatal risk factors and methacholine responsiveness. Differences between VLBW children and normal-birth-weight children in pulmonary function are modest even when statistically significant. Severity of perinatal illness influences pulmonary function parameters into late childhood.

Academic achievement and educational resource use of very low birth weight (VLBW) survivors.

Thirty-nine very low birth weight (VLBW) and 32 normal birth weight (NBW) elementary school children were studied prospectively to determine patterns of academic achievement and special education resource use during the elementary school years. Reading, spelling, and mathematical abilities were evaluated. Mean scores for the VLBW children were significantly lower on the mathematic subtests. VLBW study participants experienced more grade retention (43% vs. 23%) and required 2.8 times more special academic assistance than their NBW peers. Thus, providing special educational resources for VLBW children is essential.

The influence of early biological risk and the home environment on nine-year outcome of very low birth weight.

The contributions of early medical risk and the early and contemporary home environment on cognitive and academic outcomes of 35 nine-year-old survivors of very low birth weight (VLBW) who were followed prospectively were investigated. There were no significant relationships between the measures of early medical risk and outcome. The quality of the home environment accounted for half of the variance in outcome. Five themes that showed consistent associations over time with positive outcomes were: parental responsivity, parent support for learning, parent involvement with the child, exposure to a variety of experiences, and the presence of a father figure.

Children with disabilities.

The purpose of this article is to provide the clinician with a comprehensive review of the influence of temperament on the social and cognitive development of children with disabilities. Research concerning the interaction of temperament and cognition and the temperament characteristics of children with disabilities is reviewed. Also discussed are issues relevant to clinical practice, including assessment of temperament characteristics and interventions with parents.

Assessment of measures to detect preschool academic risk in very-low-birth-weight children.

The ability of three preschool risk detection tools to accurately identify apparently healthy very-low-birth-weight children (VLBW < 1500 g) who would subsequently experience school failure was studied. The sample of 35 children included 20 girls and 15 boys, 15 African-American children and 20 white children, who were 4 years old when assessed. The tool based on the information processing model had a significantly higher degree of specificity than the readiness or development based tools. None of the tools were sensitive enough to identify more than two thirds of the children who subsequently experienced school failure in grades K through 2.

Finishing first grade: a study of school achievement in very-low-birth-weight children.

Factors that influence school achievement in very-low-birth-weight (< 1,500 g) children were investigated at the completion of first grade. The subjects were 71 children and their primary caregivers. Thirty-nine children were very low birth weight (VLBW) and 32 were normal birth weight (NBW). After controlling for birth weight status, over one third of the variance in children's school achievement was accounted for by the age of the child's mother when she began childbearing. Birth weight status accounted for significant amounts of variance in information processing skills. Significantly more children in the VLBW group required special services and fewer were promoted to second grade, although the difference was not significant.

Vulnerability and temperament in very low birth weight school-aged children.

The purpose of this study was to investigate parental perception of vulnerability, parental subjective stress concerning children's premature birth, and child temperament in families of very low birth weight (VLBW) and normal birth weight (NBW) children. The subjects were 39 VLBW children and 30 NBW 7-year-old children and their caregivers. Data on child temperament and parental perception of vulnerability was provided by the 69 families. Families of the VLBW group rated their degree of current stress concerning their children's premature birth. There were no differences between the NBW and VLBW caregivers in their perceptions of their child's vulnerability status. Caregivers of VLBW children had significantly lower scores on degree of subjective stress specific to the premature birth than the value reported on the standardization population. Child temperament made a significant contribution to parental perception of child vulnerability status in both VLBW and NBW parents.

Development and longitudinal follow-up of low-birth-weight infants.

This paper describes factors that have influenced how investigators have conceptualized studies of low-birth-weight children and provides information on critically evaluating and interpreting results of research studies. Major findings concerning personality, temperament, and cognitive development during the preschool years of the low-birth-weight infants and their school achievement and behavior are summarized. Suggestions also are made for strengthening future studies.

Visual acuity, binocular vision, and ocular muscle balance in VLBW children.

Thirty-four very low birth weight (VLBW) 6-year olds and 31 normal birth weight (NBW) 6-year olds were assessed for visual acuity, binocular vision, and ocular muscle balance. Significantly more of the children in the VLBW group failed the tests of binocular vision and ocular muscle balance. Failure in tests of binocular vision was associated with higher numbers of days on mechanical ventilation and higher number of days in the intensive care nursery during the first months of life.

The value of early home assessment in identifying risk in children who were very low birth weight.

Demographic, medical risk variables and information obtained during early home assessments of very low birth weight infants and their families were compared in their ability to identify subsequent risk in 4-year-old children who were very low birth weight. The home assessment data were equal or better than the demographic risk variables in efficacy and efficiency.

Impact of caretaker stress on behavioral adjustment of very low birth weight preschool children.

The impact of caretaker daily stress and life strain on the behavioral adjustment of very low birth weight (VLBW less than or equal to 1,500 grams) preschool children was investigated; the degree to which the caregiving environment contributes to the effects of caretaker stress on child outcome was also explored. Subjects were 39 VLBW children (mean birth weight = 1,208 grams) and their primary caretakers, the majority of whom were their biological mothers. Data on caretaker stress and life strain, the caregiving environment, and child behavior were gathered when the children were 60 months of age. The impact of caretaker daily stress and life strain on VLBW child adjustment was moderate and similar to that of normal birth weight (NBW) children. The impact of caretaker stress appeared to be affected by the quality of the caregiving environment. Analysis showed that more behavior problems were found in VLBW 5-year-olds than expected in the general preschool population. Caretakers of VLBW 5-year-olds experienced more intense daily stress than those of NBW children.

Temperament, behavior problems, and learning skills in very low birth weight preschoolers.

The relationship between temperament, behavior problems, and learning skill abilities in preschool children who were born with very low birth weight (VLBW) is described. Subjects were 37 4-year-olds who weighed less than 1,500 grams at birth, were appropriate for gestational age, and free from congenital anomalies (M birth weight = 1,201 grams). Data were gathered when the children were 48 months chronological age and analyzed using point biserial and Pearson product moment correlation, chi square, and MANOVA. Temperament characteristics of rhythmicity, intensity, and persistence were related to behavior problems and learning skill abilities. Mothers reported more children with behavior problems than expected in the general population. Children with four or more behavior problems had significantly lower skill achievement scores than children with fewer behavior problems.

Preschool temperament of very-low-birth-weight infants.

This longitudinal study examined the toddler and preschool behavioral characteristics of children who were born with very low birth weights (VLBW; less than or equal to 1,500 grams). The subjects were 40 VLBW children (average birth weight, 1,203 grams) who at birth were appropriate for gestational age and free from congenital anomalies. Data were gathered during home visits when the children were 12, 24, 36 and 48 months and were analyzed using Pearson product moment correlation and z tests. Arrhythmicity, low adaptability, and low persistence during the toddler and preschool years characterized the behavioral styles of VLBW children. The temperament dimensions of rhythmicity, adaptability, intensity, mood, and threshold were related to the quality of the child's environment. Clinicians need to be alert to the impact of temperament on the interpersonal milieu of VLBW children and their families.