Anneli Yliherva

Two-year follow-up of a randomised trial with repeated antenatal betamethasone

Background: Weekly repeated antenatal corticosteroid treatment improves respiratory outcome but decreases fetal growth and may impair neurodevelopmental outcome. We have previously reported that a single repeat betamethasone (BM) dose neither decreased fetal growth nor improved the outcome of preterm infants during the first hospitalisation. Objective: To study prospectively whether a single repeat dose of BM influences neurodevelopment and growth within 2 years. Design: Women with imminent delivery before 34.0 gestational weeks were eligible if they remained undelivered for >7 days after a single course of antenatal BM. After stratification, a single repeat dose of BM (12 mg) or placebo was given. The children underwent neurological and psychometric examinations and a speech evaluation at a corrected age of 2 years. Setting: Prospective, blinded evaluation following the randomised multicentre trial. Patients: 259 (82%) surviving infants completed the 2-year follow-up, 120 in the BM group and 139 in the placebo group. Results: The rate of survival without severe neurodevelopmental impairment was similar in both groups (BM 98%, placebo 99%). The risk of cerebral palsy (BM 2%, placebo 1%), growth or re-hospitalisation rates (BM 60%, placebo 50%) did not differ between the groups. Conclusions: A single repeat dose of antenatal BM tended not to influence physical growth or neurodevelopment at 2 years of age.

Common variation near ROBO2 is associated with expressive vocabulary in infancy

Twin studies suggest that expressive vocabulary at ~24 months is modestly heritable. However, the genes influencing this early linguistic phenotype are unknown. Here we conduct a genome-wide screen and follow-up study of expressive vocabulary in toddlers of European descent from up to four studies of the EArly Genetics and Lifecourse Epidemiology consortium, analysing an early (15–18 months, ‘one-word stage’, NTotal=8,889) and a later (24–30 months, ‘two-word stage’, NTotal=10,819) phase of language acquisition. For the early phase, one single-nucleotide polymorphism (rs7642482) at 3p12.3 near ROBO2, encoding a conserved axon-binding receptor, reaches the genome-wide significance level (P=1.3 × 10−8) in the combined sample. This association links language-related common genetic variation in the general population to a potential autism susceptibility locus and a linkage region for dyslexia, speech-sound disorder and reading. The contribution of common genetic influences is, although modest, supported by genome-wide complex trait analysis (meta-GCTA h215–18-months=0.13, meta-GCTA h224–30-months=0.14) and in concordance with additional twin analysis (5,733 pairs of European descent, h224-months=0.20).

Trial of Early Neonatal Hydrocortisone: Two-Year Follow-Up

Background: Dexamethasone treatment is associated with an increased risk of cerebral palsy (CP). Early hydrocortisone (HC) treatment may decrease the incidence of bronchopulmonary dysplasia; however, the long-term effects are still under evaluation. Follow-up of randomized studies concerning early HC treatment is essential to confirm the long-term safety. Objective: We hypothesized that early HC treatment in very preterm infants does not impair the neurologic outcome. Methods: We report follow-up data from a randomized trial of early HC given for 10 days. Before the HC or placebo treatment, serum cortisol levels were measured. Receiver-operating characteristic was defined. Values below the median were classified as low endogenous cortisol and those above the median as high endogenous cortisol. A meta-analysis was performed. Results: Altogether 98% of the 46 surviving infants participated in a follow-up study at a corrected age of 2 years. The growth characteristics were similar between the study groups. The developmental quotients (DQs) of the children with high endogenous cortisol and placebo treatment shortly after birth (100 ± 13) and those with low endogenous cortisol and HC (97 ± 7) were not lower than the DQs of the children with high endogenous cortisol and HC (92 ± 3) or low cortisol and placebo (96 ± 2). According to a meta-analysis of three available trials (411 children), the rate of CP and survival without neurosensory or cognitive impairment was not influenced by HC. Conclusion: Early low-dose HC administration had no adverse effects at 2 years of age. Further studies are required to define the target group for neonatal HC.

Feeding skill milestones of preterm infants born with extremely low birth weight (ELBW)

AIM To compare the feeding development of preterm infants with that of full-term infants. PARTICIPANTS Nineteen preterm infants with extremely low birth weight, and 11 healthy full-term infants. METHODS Intensive follow-up study. Feeding situations were analyzed by NOMAS (Neonatal Oral Motor Assessment Scale) and by an oral motor patterns checklist based on video recorded sessions. RESULTS Most of the preterm infants showed a disorganized sucking pattern and most of the full-term infants a normal sucking pattern, as long as suckling was present. However, the early suckling pattern did not predict the schedule of later feeding development. Preterm infants seemed to learn the various feeding skills at the same corrected ages as full-term infants, with the exception of munching, which they learned earlier than the full-term infants. However, the age range for gaining these skills was wider for the preterm infants. Preterm infants also seemed to have feeding problems more often than full-term infants when qualitative features of feeding were considered. Feeding was prolonged and messy, and the preterm infants were sensitive to different qualities of food. CONCLUSION Feeding development of preterm and full-term infants is similar except for suckling, when only oral motor skills are concerned. When the qualitative characteristics of feeding are taken into account, the preterm infants suffer from feeding problems that create a risk for early interaction and communication.

Association Between Childhood Specific Learning Difficulties and School Performance in Adolescents With And Without ADHD Symptoms: A 16-Year Follow-Up

Objective: The authors investigated whether childhood specific learning difficulties (SLDs) predict later school performance in adolescents with ADHD symptoms (ADHDs) and how SLDs associate with educational aspirations. Method: In the Northern Finland Birth Cohort 1986 (n = 9,432), data about children were collected using questionnaires for parents and teachers at ages 7 and 8 and for parents and adolescents at ages 15/16. Information on school performance was obtained from a national register. Results: The occurrence of SLDs at 8 years was 19.9% (n = 1,198), ADHDs at 15/16 years was 8.0% (n = 530), and comorbid ADHDs and SLDs was 3.0% (n = 179). Having ADHDs but not SLDs or having both was associated with a significantly lower mean value in school grades for theoretical subjects. Adolescents with comorbid ADHDs and SLDs repeated a grade more often, and their educational aspirations were less ambitious than those in other groups. Conclusion: ADHDs and SLDs have a negative influence on academic achievements.

Randomised trial of early neonatal hydrocortisone demonstrates potential undesired effects on neurodevelopment at preschool age

We evaluated the neurodevelopment and growth of five‐ to seven‐year‐old children who had participated in a randomised trial of early low‐dose hydrocortisone treatment to prevent bronchopulmonary dysplasia.

language and pragmatic profile in children with aDHD measured by children's communication checklist 2nd edition

Abstract Objective. The aim of this study was to explore whether children with attention deficit hyperactivity disorder (ADHD) have language and/or pragmatic difficulties compared to typically developing children. Methods. Nineteen children with ADHD (age 5–12 years) and nineteen typically developing children (age 5–8 years) were evaluated using the Finnish version of Childrens Communication Checklist 2nd edition (CCC-2). The CCC-2 questionnaire was filled in by their parents. Results. According to the CCC-2 questionnaire, differences between the groups were found in linguistic abilities, pragmatics skills, and social interaction. Conclusion. According to the CCC-2 profiles, many children with ADHD may have various kinds of communication difficulties, even if they do not have a diagnosed language disorder.

Language abilities of 8-year-old preterm children among the northern Finland 1-year birth cohort for 1985-1986.

The language abilities of 42 8-year-old preterm children with birth weight <1750 g from a 1-year birth cohort in northern Finland was studied with four different language tests. Control children from the same birth cohort matched individually with their preterm pairs for age, sex, twinship, mothers education, place of residence, birth order and family type were also studied. In psycholinguistic test, auditory skills did not differ between the preterm and the full-term groups. Nor did any other linguistic subtest differentiate between the groups. Instead, the preterm children scored significantly poorer than their controls in visual subtests. The study also showed that the poor performance in visual tests was associated with neonatal morbidity, namely neonatal infections, need for continuous positive airway pressure (CPAP) treatment and patent ductus arteriosus (PDA). When studying the language abilities of preterm children, we suggest that qualitative methods should be used to analyse linguistic skills. We recommend versatile follow-up of preterm children until school age.

Linguistic skills in relation to neurological findings at 8 years of age in children born preterm

The linguistic skills of 8-year-old children born preterm ( n = 42) with birthweight<1750 grams from a 1-year birth cohort for 1985-86 in northern Finland were studied with three different language tests, namely the Illinois Test of Psycholinguistic Abilities (ITPA), the Token Test for Children (TTC) and the Morphological Test (MT) for Finnish children. Full-term control children ( n = 42) with birthweight S 2500 grams from the same birth cohort were matched individually with their preterm pairs for age, sex, twinship, mothers education, place of residence, birth order and family type. The preterm childrens language abilities were studied in relation to their neurological status and to the periventricular leukomalacia (PVL) findings of magnetic resonance imaging (MRI). The preterm children with minor neurodevelopmental dysfunctions (MND) scored worst and differed significantly from their matched controls in TTC. They also differed significantly from other preterm subgroups, namely healthy preterm and preterm children with cerebral palsy (CP), in verbal comprehension measured by TTC. PVL findings were not associated with performance in the language ability tests. A closer and regular follow-up of language development in the MND-disabled group among the low-birthweight preterm children is recommended.

Early vocalization of preterm infants with extremely low birth weight (ELBW), part II: from canonical babbling up to the appearance of the first word

The aim of this study was to systematically describe the preverbal development of preterm infants from canonical babbling up to the first word and to compare it with that of healthy full-term infants. In addition, the amount of vocalization between the preterm and full-term groups was compared. The sample consisted of 18 preterm infants with extremely low birth weight and 11 full-term infants. The development of preverbal vocalization before variegated babbling did not differ between the groups. Instead, the preterm infants failed to produce more different kinds of canonical syllable types than the full-term infants. However, they showed a larger variance of variegated babbling skills and remained in the babbling phase longer before reaching the first meaningful word compared with the full-term infants. Following the onset of canonical babbling, the preterm infants produced fewer vocalizations than the full-term infants and they reached the first word later than the full-term infants.