Visual and cerebral sequelae of very low birth weight in adolescents.

OBJECTIVE: To describe the visual functions and relate them to MRI findings and the intellectual level in adolescents born with very low birth weight (VLBW). DESIGN: Population-based case-control study. PATIENTS: 59 15-year-old VLBW adolescents and 55 sex and age-matched controls with normal birth weight. MAIN OUTCOME MEASURES: Objective clinical findings (visual acuity, stereo acuity and cycloplegic refraction) were recorded. Structured history taking was used to identify visual difficulties. The intellectual level was assessed with the Wechsler Intelligence Scale for Children (WISC). All VLBW adolescents underwent MRI of the brain. RESULTS: Significant differences were found between the VLBW adolescents and controls regarding visual acuity (median -0.11 and -0.2, respectively; p=0.004), stereo acuity (median 60'' and 30'', respectively; p<0.001), prevalence of astigmatism (11/58 and 0/55, respectively; p<0.001) and in full-scale IQ (mean IQ 85 and 97, respectively; p<0.001) and performance IQ (mean 87 and 99, respectively; p=0.002). The structured history also revealed a borderline significant difference between the groups (mean problems 0.46 and 0.15 respectively; p=0.051). 30% (17/57) of the VLBW adolescents had abnormal MRI findings and performed worse in all tests, compared with both the VLBW adolescents without MRI pathology and the normal controls. CONCLUSION: This study confirms previous observations that VLBW adolescents are at a disadvantage regarding visual outcome compared with those with normal birth weight. In 47%, visual dysfunction was associated with abnormal MRI findings and in 33% with learning disabilities. The adolescents with abnormal MRI findings had more pronounced visual and cognitive dysfunction. The findings indicate a cerebral causative component for the visual dysfunction seen in the present study.

Very-low-birth-weight children at school age: academic achievement, behavior and self-esteem and relation to risk factors.

OBJECTIVE: To investigate school performance, behavior and self-esteem of children with very low birth weight (VLBW). METHODS: All children with birth weight below 1501 g (VLBW) and normal birth weight controls, born in the south-east region of Sweden during a 15-month period in 1987-88, were enrolled in a prospective follow-up study. At the age of 9 years, 81% and 82%, respectively, were re-examined regarding growth, neurofunctional classification, academic achievement tests, need for special education and behavioral problems. At 12 years, 89% and 76%, respectively, were re-examined regarding growth, neurofunctional classification, visual acuity and self-esteem. RESULTS: VLBW children were shorter and lighter, and differed from the controls with regard to neurological functional classification. They produced poorer results in most academic achievement tests. When the comparison was restricted to children with normal intelligence, almost all the differences in other academic achievements disappeared. VLBW children had more reading difficulties but were less often than expected defined as dyslexics compared to control children. We did not find any major disparity in visual acuity and self-esteem between the groups. Low Apgar scores, intracranial hemorrhage and the need for mechanical ventilation neonatally were associated with poorer results in most outcome measures. Neurofunctional assessments in early childhood were associated with most outcome measures. The mother's education was related to delayed reading skills and need for special education. CONCLUSIONS: Although VLBW children performed less well in most academic achievement tests and on some behavioral subscales, those who had a normal intellectual capacity did not differ in any important aspects from the controls.

Use of healthcare resources, family function, and socioeconomic support during the first four years after preterm birth.

OBJECTIVES: To assess the use of healthcare resources for preterm infants and to evaluate family function and socioeconomic support in a defined population from birth to 4 years of age. METHODS: In a prospective case-control study, 39 singleton preterm infants without prenatal abnormalities born during an 18 month period were studied together with their families. The population consisted of 19 very preterm infants (less than 32 weeks) and 20 randomised moderate preterm infants (32-35 weeks), and the control group comprised 39 full term infants. Contacts with medical services, child health services, and the social welfare system were registered, and family function and life events were studied. RESULTS: The preterm children were more often readmitted to hospital (odds ratio (OR) 6.6, 95% confidence interval (CI) 2.0 to 22.1) and had more outpatient attendances (OR 5.6, 95% CI 2.1 to 15.0) during their first year of life. Mothers in the preterm group more often used temporary parental allowance than the control mothers (p < 0.001). The number of contacts with the child health services and the social welfare system did not differ significantly from the controls. Neither was there any significant difference with regard to family function or life events at 4 years of age. CONCLUSIONS: A large proportion of the premature children used specialist care during the first years of life. However, the families of the preterm infants were socially well adapted up to four years after birth compared with the control families.

Evaluation of an intervention programme to support mothers and babies at psychosocial risk: assessment of mother/child interaction and mother's perceptions of benefit.

The outcome of a short-term intervention programme for mothers at psychosocial risk was evaluated. The study included 63 mothers and their 0-6-month-old babies who participated in a 6-week intensive treatment programme. Mother-child interaction was assessed in the beginning and at the end of treatment by two independent staff members based on direct observation, and by two control raters who observed video recordings which were arranged in blind order. The mothers were interviewed about the treatment retrospectively. A positive change in several aspects of mother-child interaction, according to the assessments made by the raters and according to the mothers themselves. The number of mothers who were positive toward the treatment rose from 34 in the beginning of the treatment to 56 at the end. In conclusion, a short but intensive intervention seems to have a positive outcome on mother-child interaction, and was in most cases linked to a positive attitude.

The presence of psychiatric consultations in relation to divorce.

In this study all couples who during a period of 1 year were divorced at a Swedish district court, and who had children living at home, were examined for psychiatric consultations before, during and after the divorce period. Psychiatric consultation was defined as having a psychiatric record at the only psychiatric clinic in the catchment area. The divorced couples were compared with a matched group of married people. The results showed that there was a 4.1-fold higher risk for divorced men and a 2.5-fold higher risk for divorced women of acquiring a psychiatric record. The increased rate of psychiatric consultations was evident before as well as after the divorce period, but was most striking during the divorce period. A greater proportion of men than women started and continued to experience their psychiatric problems before and during the divorce period, while women more often started and continued to experience their psychiatric problems during the divorce period and afterwards.

Children of psychosocial risk-mothers: life events, social interaction, and behaviour problems at the age of 8 years.

The number of stressful life events experienced as measured on the modified Swedish version of Coddington's questionnaire, and the presence of behaviour problems assessed by Achenbach's Child Behavior Check List (CBCL) were studied in 45 eight-year-old children of identified psychosocial risk-mothers. The mothers' social network was estimated using the Swedish version of Undén and Orth-Gomér's Interview Schedule for Social Interaction (ISSI). These mothers had been identified during early pregnancy. A control group of 57 children of the same age and their mothers without the presence of psychosocial risk-criteria was used as reference. The results indicated that the index children had experienced significantly more life events, and displayed significantly more behaviour problems than the reference children. The mothers in the index group had a significantly poorer social network than the mothers in the reference group. The study suggests that children of mothers, identified early on psychosocial risk criteria develop suboptimally. Therefore, early interventions are of great importance.

Children of mothers who are at psycho-social risk. Mental health, behaviour problems and incidence of child abuse at age 8 years.

Of the 1575 pregnant women registered at the public Antenatal Health Care Service in the city of Linköping, Sweden, during 1983, an index-group of 78 women were identified who met specific well-defined psychosocial risk-criteria related to drug addiction, mental insufficiency, and particular social circumstances of possible relevance to problems of pregnancy and early child development. Seventy-eight pregnant women who did not meet the inclusion criteria were used as a reference group. The present study was an 8-year follow up in which 47 of the original index children and 57 of the original reference children were examined on indices of mental health, and the presence of child abuse. Their mental health was assessed on the basis of a Symptom and Behaviour Interview (SBI) with the mother and a Child Behaviour Checklist (CBCL) completed by the mothers and the teachers. The incidence of child abuse was obtained from Social Welfare records. The index children displayed significantly poorer mental health as assessed by the SBI and the CBCL, had a more negative self-image, and child abuse had been investigated in 30% of the index families compared to 1% in the reference families. The study suggests, based on the suboptimal development of the risk children, that screening for early psychosocial risk factors should be done routinely and be combined with early interventions.

Mental health among immigrant and refugee children of divorced parents.

The mental status of 27 children in divorced immigrant families and 17 children in divorced refugee families was examined, and compared to that of 113 children in divorced Swedish families. Differences in divorce-pattern between these families and Swedish divorced families were analysed. Viewed together, the immigrant and refugee children displayed a significantly higher symptom load compared to Swedish children from both divorced and intact homes. When examined separately, the refugee children but not the immigrant children were more troubled than Swedish children from divorced families. The shorter time the children had spent in Sweden, the higher was their symptom load. In comparison to Swedish divorced couples, the immigrant and refugee couples had been married for a shorter time, had been unhappy for a longer time prior to divorce, and joint custody was less common. Most of the marriages had been unhappy before the arrival in Sweden, but a dissolution had not been seen as feasible earlier. As among the Swedish couples, it was the woman who had initiated the divorce in most cases, and it was also the mother who became the residential parent in most cases.

Divorce: different experiences of men and women.

Demographic variables, the reasons for the divorce, the changes as a consequence of the divorce and the differences between the sexes were studied among 157 Swedish-speaking spouses through interviews and assessments on visual analogue scales. The results showed that various conflicts were the main reason for the divorce in half of the families. Compared to men, women came significantly more often from broken homes, were the initiators of the divorce in most cases, and felt that the marriage had been dissatisfying for a significantly longer time period. Self-employed men were significantly overrepresented. The changes as a consequence of the divorce were significantly different for men and women in several areas, in most cases in favour of the women.

Neurofibromatosis in childhood: neuropsychological aspects.

Neurological findings, difficulties in reading and writing, and behavior disturbances in 27 children with neurofibromatosis were analyzed. Neurological symptoms such as seizures and motor disturbances were found in 37%. Tumors, mainly optic gliomas, and arachnoidal cysts were seen by computerized tomography in 26%. There was an overall functioning within the average range of intelligence; obvious mental deficiency, however, was found in 11%. Difficulties in reading and writing were present in 41%, and 47% had a school performance below average. Behavior disturbances outside the normal range were present in 28% which is significantly more frequent than in children of a normal population. The high rate of school problems and behavior disturbances indicates that early diagnosis and early counseling concerning behavior treatment and special school education are important issues in the care for children with neurofibromatosis.