Alison Elliman

Coordination in Low Birthweight Seven-Year-Olds

ABSTRACT. The coordination and laterality of a group of 171 seven‐year‐old children, free from major disability, with a birthweight of 2000 g or less, were examined and compared with those of normal birthweight peers. More low birthweight children were left‐handed and of mixed or undetermined hand, foot and eye dominance. Left‐handedness may adversely affect some areas of performance of normal birthweight but not of low birthweight children. Low birthweight children performed significantly less well in tests of both fine and gross motor coordination. Girls tended to perform better than boys in fine motor tests. In the low birthweight group there was a correlation between IQ and coordination.

DENTAL DEVELOPMENT IN LOW BIRTHWEIGHT (LBW) CHILDREN UNTIL SEVEN YEARS OF AGE

A dental study was incorporated into a follow up study of LBW children (birthweight <2000g). The aim was to compare the prevalence of enamel defects, tooth size and eruption of teeth in LBW children with normal birthweight controls. Dental examinations were performed at 3, 5, and 7 years to determine the prevalence of enamel hypoplasia. Dental casts were made at 7 years to measure deciduous tooth size. The deciduous teeth of the LBW children, were significantly (p<.001) smaller had significantly more enamel hypoplasia and erupted significantly later than controls. When age was corrected for premuaturity there was no significant difference in eruption times. More hypoplasia occurred in the deciduous teeth of the LBW children who suffered major neonatal problems. The LBW group however did not show an incresed prevalence of hypoplasia in the permanent teeth. It is suggested that as the deciduous teeth calcify both pre and postnatally a systemic upset during the neonatal period disturbs the enamel forming at that time, whereas the permanent teeth do not start to calcify until around birth and, particularly in a premature child, may escape this insult.

54 SCHOOL PERFOMANCE OF LOW BIRTHWEIGHT CHILDREN

Standardised tests of mental and psychomotor development were administered to 175 low birthweight (LBW) children (bw<2000g) at a mean age of 7.1 years. WISC IQ scores were within the average range X 101) as were Neale reading profiles X 7.4 years). Errors on the Bender-Gestalt were average (5) but drawing was relatively immature (38%). Multiple regression statistics indicated that social class was the main predictor for intellectual performance. However, drawing was significantly poorer in small for gestational age children (p<.002) and visuo-motor errors were more likely in those with a BW less than 1500 grams (p<.003). Severity of neonatal illness was a significant predictor for poor drawing skills (p<.03), perceptual-motor errors (p<.002), and limited concentration (p<.04) and persistence (p<.01). These results support the findings of others that the major deteriainant of academic achievement is parental background. However, neonatal factors do have a significant impact on abilities which are fundamental to essential basic skill (e.g. handwriting) and the processing on new information (e.g. attention).

38 HAND EYE COORDINATION IN 7-YEAR OLD LOW BIRTHWEIGHT CHILDREN

As part of a larger study, hand-eye coordination was measured in a group of low birthweight (LBW) (BW2000g) 7 year olds attending normal school, and a control group of normal birth-weight children selected from local schools. Children with cerebral palsy were excluded. The distribution of sex, social class and race was similar in the two groups but there were significantly more first surviving and only children in the LBW group (p<.005). LBW children were less good at finger-nose pointing (p<.01), diadochokinesis (p≪.001) and finger opposition using both hands simultaneously (p<.05). There was no significant difference in the ability to throw a ball up and catch it, but LBW children were less able to clap while the ball was in the air (p<.001). Within the LBW group there was no significant difference between children of different birth weight, sex or gestation, but children who were appropriate for gestational age (AGA) were better at diadochokinesis than those who were small for gestational age (p<.05). These findings show that LBW children are less good at hand-eye coordination than children of normal birthweight*

171 LOW BIRTHWEIGHT CHILDREN - HOW TALL ARE THEY AT THREE|[quest]|

As part of an ongoing study of all babies with a birthweight of 501-2000 grams inclusive born at or transferred into Hammersmith and Queen Charlottes Maternity Hospitals, London, in a one-year period from June 1979 to May 1980, 176 children were weighed and measured at birth and three years. They were classified as small for gestational age (SGA)(birthweight below tenth centile for gestational age) or appropriate for gestational age (AGA). Three-year-old heights and weights are expressed as standard deviations (SD) from the norm using both real age (RA) and age corrected for prematurity (CA). Thus two values were obtained for each child. Using RA the mean weight at three years was -0.9 SD and mean height -0.4 SD, but after correction the mean weight was -0.7 SD and mean height 0.0 SD. AGA children and children with birthweights over 1500 g were significantly taller (p<0.001). Sex and length of gestation did not appear to affect height at three years. In general the childrens height was higher than weight on the growth chart; the higher the height or lower the weight the greater the discrepancy. These findings suggest that in as far as three-year-old height can be used to predict adult height, these low birthweight children will not differ from the general population as adults.

HEAD NARROWING IN PRETERM INFANTS

The marked narrowing of the head which develops in many preterm infants often causes concern to their parents, who may worry that the unusual shape will persist or that it may be associated with intracranial pathology and developmental delay. The biparietal (BP) and anteroposterior (AP) diameters were measured weekly in 203 preterm infants during their stay in NICU, and at regular intervals up to three years of age. The AP/BP ratio was calculated (Baum J D and Searls D, Dev Med and Child Neurol. 1971 13: 576-581). This ratio rose from a mean of 1.36 in the first week to a mean of 1.48 at six weeks and fell to a mean of 1.42 by 13 weeks. Less mature babies and those with lower birth weights showed more flattening but this was not statistically significant. The presence of intracranial pathology detected by ultrasound did not affect head shape. 11% of babies showed marked early flattening (AP/BP ratio 1.55). These were compared with the rest of the group. At three years there was no significant difference in AP/BP ratio or in Griffiths Development Quotient. We conclude that by the age of 3 years the babies showing very marked early head flattening did not differ from the rest of the cohort in the areas examined.(NICU = Neonatal Intensive Care Unit)

ENAMEL DEFECTS IN DECIDIOUS DENTITION OF LOW BIRTH WEIGHT INFANTS

Enamel defects have been observed in the deciduous dentition of preterm infants, but few systematic studies have been carried out. A dental examination is part of the study of a cohort of infants weighing 2000g or less at birth for which comprehensive neonatal and maternal medical histories are available. The Fédération Dentaire Internationale index for developmental defects of enamel was used to record opacities (defective calcification), hypoplasis (deficient amount of enamel) or discolouration. Data from 86 children aged 3-5 years showed a much higher prevalence of defects than that found in a normal population (Murray J Shaw L Arch Oral Biol 1979; 24: 7-13 71 (81%) were affected with 49 (56%) having hypoplasia of one or more incisor. In our study, enamel was frequently missing from the incisal edge of incisors. This enamel begins to calcify at 4 months of intrauterine life and is maturing at birth. 16 children who had major neonatal illness all had hypoplasia of the incisal edge of one or more incisor. This may indicate developmental disturbances in the second half of pregnancy or reflect post-natal influences on maturation. Trauma from endotracheal intubation has been postulated as an aetiological factor but due to the symmetry of the lesion the authors favour sytemic disturbances.

THE GROWTH OF LOW BIRTH WEIGHT 3 YEAR OLDS

177 children (81% of a cohort of 218 weighing 2000g or less at birth) were measured regularly until the age of 3 years. At 3 years the weights of 36% (53% SGA and 26% AGA) were <10th centile, and of 11% (5% with handicap) <3rd centile. The heights of 23% (31% SGA, 18% AGA) were <10th centile. When height was corrected for prematurity only 11% were <10th centile, suggesting that many childrens heights were close to this centile. If they continued on their 3 year old centile their adult height would be close to the tenth centile. Categorising them as “below the 10th centile” gives a misleading pessimistic impression. Comparison with the weight centile at 6 month showed that 33% crossed the 10th centile by 3 years. The predictive value of the weight at 6 months was better for boys than girls. The study confirmed the findings of previous workers and showed that predictions about growth cannot reliably be made at 6 months. Furthermore, many of those whose height was below the 10th centile at 3 years may well attain an acceptable adult height. SGA = Small for Gestational Age, AGA = Appropriate for Gestational Age.