Anneke M. Schreuder

Prediction of height achievement at five years of age in children born very preterm or with very low birth weight: continuation of catch-up growth after two years of age

To predict height at five years in a cohort of 565 very preterm and/or very low‐birth‐weight children, hypothesized growth determinants were subjected to discriminant analysis. Many neonatal parameters were not significantly associated with short stature at five years of age. A correct classification of stature (smaller/larger than the 10th percentile at five years of age) could be obtained in 85% of children, using the following variables: height at two years of age; total (or mid) parental height; parental level of education; length at one year of age; hypertension during pregnancy; sex; weight at two years of age; length percentile at one year of age. However, when compared to actual longitudinal data, the false‐positive rate was 37%. The survey also demonstrated the continuing catch‐up growth in very preterm and very low‐birth‐weight infants after two years of age.

OUTCOME OF PERIVENTRICULAR-INTRAVENTRICULAR HAEMORRHAG FIVE YEARS OF AGE

The authors studied the relationship between periventricular‐intraventricular haemorrhage in infants of <32 weeks gestation who had undergone routine cranial ultrasound scanning in the neonatal period, and neurodevelopmental outcome at the age of five years. Of 484 infants enrolled into the study, all 304 survivors were available for follow‐up at the age of five years. 85 children had a disability; in 50 of these, the disability caused a handicap. Three children with dilated lateral ventricles and no periventricular‐intraventricular haemorrhage were excluded from further analyses. 26 per cent of the infants with severe (grades III/IV) haemorrhage and 67 per cent of the infants with mild (grades 1/11) haemorrhage survived the neonatal period. Children with mild haemorrhage had a significantly increased risk of disability (including handicap) at the age of five years.

TRANSIENT NEONATAL HYPOTHYROXEMIA MAY CAUSE NEUROLOGICAL IMPAIRMENT

Objective: to study the relationship between neonatal thyroid function and neurological outcome.Methods: In 632 children born with gestational age < 32 weeks and/or birthweight < 1500 g (part of the POPS-study 1983). T4 values from the neonatal screening program on congenital hypothyroidism (day 5-17) were available as well as data on neurological impairment (Minor Neurological Dysfunction (MND, n-126) or Cerebral Palsy (CP, n-68). Univariate (parametric and non-parametrie 1-way Anova) and multivariate analysis (logistic regression analysis) were performed relating T4 to neurological impairment as outcome measure.Results: the mean T4 value was lower in MND and in CP (Kruskal-Wallis: p=0.06; parametric Anova: p=0.05). This relationship was confirmed in the multivariate analysis; after correction for 10 possible confounding factors, a significant association was found between low T4 and neurological impairment (adding T4 as a continuous variable to the model with those 10 variables improved the fit significantly: likelihood ratio 4.1, p=0.04). In a subpopulation of 228 children with known grading of ICH, severity of ICH was found not to influence this association when added to the set of confounders.Conclusion: transient neonatal hypothyroxinemia may be one of the preventable factors contributing to neurological impairment in preterm infants.

236 ANTENATAL GLUCOCORTICOID ADMINISTRATION IN A NATIONWIDE COHORT OF VERY PRETERM AND VERY LOW BIRTHWEIGHT INFANTS: FOLLOW-UP AT 5 YEARS OF AGE

The relationship between antenatally administered glucocorticoids and overall outcome at 5 years of age, applying stepwise logistic regression analyses with 14 confounding factors, was studied. Data were collected on 1338 liveborn infants (gestational age <32 wks and/or birthweight < 1500 g) born in 1983 in the Netherlands. Data were analyzed in a subset of 671 infants (gest. age ≥ 26 and <32 wks) of whom 642 had been assessed at 5 years of age (loss to follow-up 4.3%). Overall outcome expressed as impairment, disability or handicap (WHO, 1980) was based on: congenital malformation, neuromotor function, mental development, hearing, visual function, language and speech development, musculoskeletal system, respiratory tract. There was no higher risk of impairment at 5 years of age in children of treated mothers versus non-treated mothers. With disability or handicap as outcome variables there was a significant interaction of glucocorticoid treatment and tocolysis. In the presence of tocolysis (>24 hours) there was no higher risk on disability or handicap at 5 years of age. In 13 children whose mothers received no tocolysis or only < 24 hours, the antenatal administration of glucocorticoids was associated with a significantly higher risk on disability or handicap, probably a result of confounding by indication of the treatment.

LANGUAGE AND SPEECH DELAY AT 1, 2, AND 5 YEARS OF AGE IN VERY PRETERM AND VERY LOW BIRTHWEIGHT INFANTS

Results of language screening in a nationwide collaborative study of a virtually complete year cohort of 1338 infants with a gestational age <32 weeks or with a birthweight of <1500 grams were reported. At the age of 1 and 2 years the language items derived from the Van Wiechen ncurodevelopmental assessment and at 5 years the VTO-language screening test were used, both validated for the Dutch language. Language delay was recorded in 16%, 23%, and 24% respectively at 1, 2, and 5 years of age (corrected for preterm birth).In a multiple logistic regression analysis a relationship of language delay at 5 years was found with perinatal risk factors: level of parental education, multiple pregnancy, birthweight, male sex, and neurological status at discharge. Both language delay at 1 year and at 2 years were predictors for delay at the age of 5 (OR 2.2 and OR 2.9). Disability not due to language delay at 5 years of age was related to language delay (OR 3.2). Particularly disabilities of mental development and neuromotor function and to a lesser extent disabilities of visual function and hearing loss were involved. At 5 years 12% is already attending special education. As language delay is a strong predictor of school failure in the coming years a considerable increase of this percentage is expected.

41 EXTREMELY LOW BIRTHWEIGHT INFANTS: LIVE OR LET DIE?

As part of the national collaborative study in The Netherlands on very preterm and very low birthweight infant liveborn in 1983, we studied mortality and disabilities at 5 years of age in 292 infants with birthweight below 1000 grams. Mortality was 55.5%; in more than half of these cases, treatment was withheld or withdrawn. In 128 of 130 surviving children a detailed neurodevelopmental assessment was done during a home visit by 1 of 3 specially trained paediatricians. According to the WHO definitions1 38 children (29.7%) had a disability of which 16 (12.5%) had a minor handicap and 6 (4.7%) a major handicap.Although birthweight was clearly related to mortality, withdrawal of treatment was evenly distributed over all birthweight categories, and disabilities or handicaps showed no association with birthweight within this studygroup. We conclude that, given the permissive attitude on withholding or withdrawal of treatment in The Netherlands, tiny babies have a higher mortality risk, but in surviving children the disability and handicap percentages are similar to that in survivors of 1000-1500 g (disabilities 28.22, handicaps 14.3%).

COMPARISON OF OUTCOME IN VERY PRETERM AND VERY LOW BIRTHWEIGHT INFANTS AT THE AGE OF TWO AND FIVE YEARS

In the nationwide cohort (1338 liveborn infants <32 weeks and/or < 1500 g), infant mortality was 27.2 % (n=364). At the age of 5 years 944 children could be traced; of these, 911 were examined during a home visit. Preliminary results of 542 children show a major handicap in 24 children (4.4%); minor handicap was present in 25 children (4.6%). Comparison to the results of the follow-up study at 2 years in the same children (4.2% and 10.0% respectively) showed a similar major handicap rate and a lower minor handicap rate.However, shifting between the various subgroups (normal, minor and major) had occurred, a more favourable outcome was seen in 52 children and a less favourable in 23 children. Possible explanations of such shifts will he discussed.