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.

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.

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.