Respiratory health in prematurely born preschool children with and without bronchopulmonary dysplasia.

OBJECTIVE: To investigate the respiratory health of preterm infants with bronchopulmonary dysplasia (BPD) at preschool age and to determine whether lung function (measured by forced oscillation technique (FOT) and interruption technique (Rint) is affected by BPD in preterm infants compared with preterm infants without BPD. PARTICIPANTS: 3 to 5 years of age born preterm with BPD (N = 40, mean gestational age 28 weeks, mean birth weight 1051 g), and without BPD (N = 36, mean gestational age 29 weeks, mean birth weight 1179 g). OUTCOME VARIABLES: prevalence of symptoms determined by European Community Respiratory Health Survey and lung function measured by FOT and Rint. RESULTS: A large percentage of infants in both preterm groups reported respiratory symptoms during the last 12 months. Lung function measurements showed higher resonant frequency (Hz) in BPD compared with non-BPD (mean 26.8 vs 22.7, P < .001) and lower mean reactance X(4-24) (hPa.s/l)(-3.0 vs -1.9, P = .005). No differences were found in respiratory resistance between the groups, although the mean values of both groups were increased compared with reference values. CONCLUSION: Preterm birth affects respiratory health at 3 to 5 years of age. Children with BPD could be distinguished from children without BPD based on a higher resonant frequency and a lower mean reactance.

[Syndromes 19. Fetal alcohol syndrome]. / Syndromen 19. Het foetaal alcoholsyndroom.

Foetal alcohol syndrome is a syndrome with a rather high incidence. It is characterized by mental retardation, growth deficiency, a striking facial appearance (a.o. short palpebral fissures, short, upturned nose, hypoplastic philtrum, hypoplastic maxilla). Malocclusion and a disturbed facial growth may occur. Mental retardation can interfere with dental treatment.

Development of postural adjustments during reaching in infants with CP.

The development of postural adjustments during reaching movements was longitudinally studied in seven infants with cerebral palsy (CP) between 4 and 18 months of age. Five infants developed spastic hemiplegia, one spastic tetraplegia, and one spastic tetraplegia with athetosis. Each assessment consisted of a simultaneous recording of video data and surface EMGs of arm, neck, trunk, and leg muscles during reaching in various lying and sitting positions. The basic organization of postural adjustments of the children developing spastic CP was intact. Their main problem was a deficient capacity to modulate the postural adjustments to task-specific constraints - a deficit which was attributed to a combination of an impaired motor coordination and deficits in sensory integration. The child with spastic-dyskinetic CP showed distinct abnormalities in the basic organization of postural adjustments.

Development of postural adjustments during reaching in preterm infants.

Preterm infants often show postural abnormalities, such as hyperextension of neck and trunk, which can interfere with motor and cognitive development. Little is, however, known on the pathophysiology of postural development in preterm infants. Therefore, we longitudinally studied the development of postural adjustments during reaching movements in 12 preterm infants between the (corrected) ages of 4 and 18 mo. Five infants showed minor neurological dysfunctions at 18 mo, such as a mild diffuse hypotonia, a mild hypertonia of the legs, or a mild asymmetry in posture and motility, and seven infants were neurologically normal. Each assessment consisted of a simultaneous recording of video-data and surface electromyograms of arm, neck, trunk, and leg muscles during reaching in various lying and sitting positions. Comparable data on postural development in ten full-term infants were available. The preterm infants showed an excessive amount of postural activity during reaching movements at all ages studied. Moreover, the postural adjustments were temporally disorganized and could not be modulated with respect to the velocity of the arm movement and the initial sitting position. We hypothesized that the preterms' disability to modulate their postural adjustments might be due to a reduced capacity to learn from prior experience. In our small group the postural dysfunctions were not related to the presence of hyperextension at early ages, to the neurological outcome at 18 mo, or to the lesions found on the neonatal brain ultrasound scans.