Traumatic perforation of the lamina cribrosa during nasal intubation of a preterm infant.

Traumatic perforation of the lamina cribrosa and penetration of the brain occurred during nasotracheal intubation of a preterm infant requiring resuscitation. This rare complication is specifically associated with the nasal route of intubation. The complication resulted in significant morbidity. The infant developed an extensive intracranial hemorrhage and posthemorrhagic hydrocephalus that required ventricular drainage. We recommend that nasotracheal intubation be performed with utmost care. We confirm Cameron and Lupton's recommendation of using a small feeding tube over which to slide the endotracheal tube. Despite extensive iatrogenic damage, the patient's neurodevelopmental follow-up at 2 years 9 months appeared relatively mild.

Visuospatial perception in children born preterm with no major neurological disorders.

OBJECTIVE: Many investigations have found deficits in visuospatial perception in children born preterm, however, it is not clear whether the deficits are specific to visuospatial perception or the consequences of deficits in other functional areas, which often accompany preterm birth. This study investigated whether children born preterm show a specific deficit in visuospatial perception. METHOD: Fifty-six 7- to 11-year-old preterm born children (gestational age <34 weeks) without cerebral palsy and 51 age-matched, full-term children completed four computerized tasks tapping different levels and types of visuospatial perception. Accuracy and speed of responses were recorded. Task formats were designed to reduce demands on attentional deployment. Measures of intelligence and parental education were included in the analysis. RESULTS: Children born preterm performed less accurately and/or less rapidly on all tasks. Their poorer performance did not reflect differences in speed-accuracy trade-off. Parental education and IQ, both significantly lower in the preterm children, contributed positively to performance on all tasks. IQ mediated the association between preterm birth and visuospatial performance on the most cognitively demanding task. CONCLUSION: Children born preterm performed more poorly than full-term controls on four visuospatial perceptual tasks. Although intelligence and parental education were also associated with performance, preterm birth contributed independently of these factors on three of four tasks. Many children born preterm are thus multiply disadvantaged on visuospatial tasks: the lower IQ scores and parental educational levels frequently found in this group increase the deficit associated with preterm birth.

The quality of preterm infants' spontaneous movements: an early indicator of intelligence and behaviour at school age.

BACKGROUND: The quality of very preterm infants' spontaneous movements at 11 to 16 weeks post-term age is a powerful predictor of their later neurological status. This study investigated whether early spontaneous movements also have predictive value for the intellectual and behavioural problems that children born very preterm often experience. METHODS: Spontaneous movement quality was assessed, using Prechtl's method, at 11 to 16 weeks post-term in 65 infants born at

Quantitative aspects of the early motor repertoire in preterm infants: do they predict minor neurological dysfunction at school age?

BACKGROUND: Qualitative aspects of the motor repertoire, at 11-16 weeks post-term are predictive for minor neurological dysfunction (MND) at 7 to 11 years of age. Predictive value of quantitative aspects is unknown so far. AIM: To investigate whether quantitative aspects of the motor repertoire between 6 and 24 weeks post-term also have predictive value for neurological outcome at 7 to 11 years of age. STUDY DESIGN: Prospective cohort study. SUBJECTS: Preterm infants from whom several quantitative aspects of the motor repertoire were assessed between 6 and 24 weeks post-term. OUTCOME MEASURES: Neurological outcome at 7-11 years of age was assessed according to Touwens' neurological examination. Children were classified as neurologically normal, or as having complex MND or cerebral palsy (CP). RESULTS: Eighty-two children were included. At 7 to 11 years of age 15 children (18%) had developed CP, 49 (60%) were neurologically normal, and 18 (22%) had MND. Multiple logistic regression analysis showed that, when the qualitative aspects of the motor repertoire known to predict neurological outcome were taken into account, only the asymmetric tonic neck (ATN) posture provided additional predictive value. In case of normal fidgety movements (FMs) accompanied by an abnormal concurrent motor repertoire, the presence of an obligatory ATN increased the risk for developing complex MND to 75%; absence of an obligatory ATN reduced the risk to 15% (p<0.05). CONCLUSIONS: Quantitative aspects of the motor repertoire at 11-16 weeks post-term, in particular the presence of an obligatory ATN posture, contribute to the prediction of neurological outcome at 7 to 11 years of age.

Movement adaptations in 7- to 10-year-old typically developing children: evidence for a transition in feedback-based motor control.

We used a modified double-step pointing task to study movement adaptations in 7- to 10-year-old typically developing children. We found that the majority (63%) were able to optimally adapt fast, goal-directed visually-guided movements to a late change in target location meeting the requirements of speed and accuracy. A minority (35%) failed to meet the requirement of accuracy resulting in a less optimal adaptation. The results showed that the ability to adapt movements optimally develops before the age of 7 years in typically developing children. Literature proposes a transition in development of motor control around the age of 8 years. The present results replicate and extend this by suggesting that this transition affects the later phases of fast, goal-directed visually-guided movements rather than the early phases, such as movement programming and acceleration. Finally, the results indicate that the optimally adapted movements were the result of a specific strategy in which a specific component of movement execution was slowed on all trials. This suggests that 7- to 10-year-old typically developing children have developed implicit knowledge about which movement components are the most efficient to adapt.

Effect of seat surface inclination on postural control during reaching in preterm children with cerebral palsy.

BACKGROUND AND PURPOSE: Because it is debatable whether seat surface inclination improves motor function in children with cerebral palsy (CP), the effect of seat surface tilting on postural control and quality of reaching was studied. SUBJECTS: The subjects were 58 children with CP aged 2 to 11 years (34 with unilateral spastic CP, 24 with bilateral spastic CP). METHODS: During the task of reaching movements, surface electromyographic and kinematic data were recorded for posture and reaching with the dominant arm in 3 sitting conditions: horizontal seat surface, seat surface tilted forward 15 degrees, and seat surface tilted backward 15 degrees. RESULTS: In the children with unilateral spastic CP, forward tilting improved postural efficiency and quality of reaching. In the children with bilateral spastic CP, both forward and backward tilting of the seat surface was associated with more postural instability and did not affect the quality of reaching. DISCUSSION AND CONCLUSION: The results suggest that, in terms of postural control and quality of reaching, children with unilateral spastic CP benefit from a forward-tilted position and children with bilateral spastic CP benefit from a horizontal sitting position.

Kinematic characteristics of postural control during reaching in preterm children with cerebral palsy.

The relationships between kinematic characteristics of sitting posture during reaching movements of the dominant arm and 1) the kinematics of the reaching movement itself and 2) functional performance during daily life activities (PEDI) were assessed in 51 sitting preterm children with cerebral palsy (CP). The children were 2-11 y, 33 had spastic hemiplegia (SH) and 18 bilateral CP (Bi-CP). The data were compared with those of 26 typically developing children (TD). Sitting posture before the onset of reaching of children with CP differed from that of TD children: they sat with a more reclined pelvis and a more collapsed trunk. The more reclined pelvic position was associated with a better quality of reaching movements. The different sitting postures of pelvis and trunk were not related to functional performance during daily life activities. Displacement of the head, trunk, and pelvis of the children with CP did not differ from that of the TD children. Nevertheless, in the children with CP a more stable head, a more mobile trunk, and a more stable pelvis were related to better functional performance and/or a better quality of reaching. This suggests that physiotherapeutic guidance of children with CP should focus rather on the latter postural parameters than on the different sitting posture of pelvis and trunk.

Kinematic characteristics of reaching movements in preterm children with cerebral palsy.

Kinematic characteristics of reaching movements of the dominant arm were assessed in 51 sitting preterm children who were aged 2-11 y and had cerebral palsy (CP), including 33 with spastic hemiplegia and 18 with bilateral CP (Bi-CP). Reference data of 29 typically developing children were present. The results indicated that the quality of reaching movements from the dominant arm of children with CP was significantly worse than that of typically developing children. This held true in particular for the children with Bi-CP. For example, reaching movements of children with CP took more time and consisted less often of one movement unit. The quality of reaching was related to the severity of lesion present on the neonatal ultrasound scan of the brain, the severity of motor disorder, the degree of spasticity, and the ability to perform activities of daily life. The last indicates that movements of the dominant arm in children with spastic hemiplegia and Bi-CP deserve clinical attention.

Quality of general movements and the development of minor neurological dysfunction at toddler and school age.

OBJECTIVE: To evaluate the reliability of assessing infants' general movements (GMs) using a new classification and its validity in predicting complex minor neurological dysfunction (MND) at toddler and at school age. DESIGN: Prospective study of two groups of infants, each consisting of a mix of low-risk and high-risk infants. SETTING: University Hospital Groningen, the Netherlands. SUBJECTS: Group A consisted of 16 low-risk and 21 high-risk infants; group B of 28 low-risk and 24 high-risk infants. MAIN OUTCOME MEASURES: Between term age and four months post term: multiple assessments of neurological condition by means of (a) assessment of GMs, and (b) a traditional neurological examination. GMs were classified into four classes using a standardized qualitative description: two classes of normal movements (normal-optimal and normal-suboptimal) and two classes of abnormal movements (mildly and definitely abnormal movements). Follow-up neurological examination with special attention to presence of MND was carried out in group A at 1 1/2 years, in group B at 4-9 years. RESULTS: GMs could be assessed reliably. They were stable over age in about 60% of the infants. Both the condition of the GMs and the infant neurological condition were significantly related to neurological condition at follow-up. Best prediction of complex MND was achieved when both types of infant assessment at the age of 2-4 months post term were combined. CONCLUSIONS: The assessment of GMs is a valuable tool, in particular when combined with the traditional neurological examination, to predict at early age the development of complex MND.

Postural control during reaching in preterm children with cerebral palsy.

Postural control during reaching with the dominant arm was assessed in 58 preterm children with cerebral palsy (CP) aged 2 to 11 years, comprising 34 with spastic hemiplegia (17 males, 17 females) and 24 with bilateral spastic CP (bilateral CP; 15 male, 9 females). Assessments were made by multiple surface electromyogram (EMG) and kinematic recording. Mean gestational age at birth for the children with spastic hemiplegia and those with bilateral CP was 28.6 weeks (SEM 0.33) and 28.2 weeks (SEM 0.34) respectively; their mean birthweights were 1158 g (SEM 58) and 1190 g (SEM 59) respectively. All but one of the children with spastic hemiplegia could walk without restriction, the exception being a child who had self-mobility with limitations. In the group of children with bilateral CP, nine walked without assistive devices, 10 could walk with assistive devices, and five children needed a wheelchair for self-mobility. Comparison data of 29 typically developing children (10 males, 19 females) born at term with appropriate birthweight were available. Results indicated that in most children with CP the basic level of postural control ('direction-specificity', i.e. muscle activation on the side opposite to direction of body sway) was intact. However, the children with CP showed dysfunctions in: (1) recruitment order of the postural muscles, i.e. they exhibited a stereotyped top-down recruitment; and (2) the ability to modulate muscle contraction (that registers on EMG) to task-specific conditions. The latter dysfunction was more pronounced in children with bilateral CP than in those with spastic hemiplegia. Postural dysfunctions were correlated to some extent with the degree of disability in everyday activities as assessed by the Pediatric Evaluation of Disability Inventory.

Maternal rigidity in infancy and level of intelligence at school age in children born preterm.

Forty-four children who had been born preterm and their mothers participated in the follow-up study. At 3 and 14 months (corrected age) cognitive development was assessed using the BOS 2-30, the Dutch version of the Bayley Scales of Infant Development. The BOS yields measures of mental and motor development. At 7.5 years, intelligence was measured using the WISC-RN, the Dutch version of the WISC-R. A composite measure of maternal rigidity, tapping rigidity as a personality trait and rigid attitudes to child-rearing was used. The results of a multiple regression analysis indicated that maternal rigidity, measured in the first year of the child's life, was not associated with mental performance at 3 or 14 months. At 7.5. years, however, it was strongly associated with cognitive development, contributing uniquely to performance IQ.