Bregje A. Houtzager

High incidence of multi-domain disabilities in very preterm children at five years of age

OBJECTIVESnTo describe the prevalence and co-occurrence of disabilities and their association with parental education in preterm children and term control subjects.nnnSTUDY DESIGNnIn a prospective study, preterm children (n=104), born at <30 weeks gestation or birth weight <1000 g, and term children (n=95) were assessed at corrected age 5 with an intelligence quotient (IQ) test, behavior questionnaires for parents and teachers, and motor and neurologic tests. A disability was defined as results in the mild abnormal range of each test or below. Associations of outcomes with parental education were studied.nnnRESULTSnOf the preterm children, 75% had at least one disability and 50% more than one, compared with 27% and 8%, respectively, of term control subjects (P<.01). The preterm-term difference in full scale IQ increased from 5 IQ points if parental education was high to 14 IQ points if it was low, favoring the term children in both groups. A similar pattern was found for behavior, but not for motor and neurologic outcome.nnnCONCLUSIONSnDisabilities occur frequently after very preterm birth and tend to aggregate. Neurologic and motor outcomes are mostly influenced by biologic risk, and social risks contribute to cognitive and behavioral outcome.

Prediction of cognitive abilities at the age of 5 years using developmental follow-up assessments at the age of 2 and 3 years in very preterm children

Aimu2002 This study investigated prediction of separate cognitive abilities at the age of 5u2003years by cognitive development at the ages of both 2 and 3u2003years, and the agreement between these measurements, in very preterm children.

Development and Validation of the Distress Thermometer for Parents of a Chronically Ill Child

OBJECTIVEnTo develop and validate a Distress Thermometer for Parents (DT-P) for chronically ill children and to determine a cutoff score for clinical distress.nnnSTUDY DESIGNnParents of a chronically ill child (0-18 years) were recruited via announcements or were actively approached at the outpatient clinics of the Emma Childrens Hospital/Academic Medical Center and Vrije Universiteit Medical Center. We modeled the development of the DT-P on the Distress Thermometer used in oncology medical care. The DT-P consists of a thermometer score from 0 (no distress) to 10 (extreme distress) and a problem list (practical, social, emotional, physical, cognitive, and parenting domains). The DT-P was validated with the Hospital Anxiety and Depression Scale (HADS) and the Parenting Stress Index.nnnRESULTSnThe mean thermometer score of the 706 participating parents was 3.7 (SD 3.0). The thermometer score and the scores in the practical, emotional, physical, and cognitive problem domains were strongly related to anxiety, depression, and the total score of the HADS (0.55 ≤ r ≤ 0.72). The thermometer score and all problem domain scores were moderately-to-strongly related to the Parenting Stress Index (0.38 ≤ r ≤ 0.63). A cutoff-score of 4 correctly identified 86% of clinical HADS cases (sensitivity) and 67% of nonclinical HADS cases (specificity).nnnCONCLUSIONSnWe developed the DT-P and examined its diagnostic utility in a large sample. The DT-P appeared to be a valid and useful short screening-tool for identifying parental distress.

Behavioural problems at the age of eleven years in preterm-born children with or without fetal brain sparing: A prospective cohort study

BACKGROUNDnIn severe intrauterine growth restriction (IUGR) due to placental insufficiency a haemodynamic adaptation occurs, resulting in preferential blood flow to the fetal brain (brain sparing). With Doppler ultrasound an increased ratio between the umbilical and the cerebral artery pulsatility index (U/C ratio) can be demonstrated. IUGR is associated with impaired neurodevelopmental outcome.nnnOBJECTIVEnEvaluation of the effect of fetal brain sparing on behavioural problems at eleven years in premature born children.nnnMETHODSnProspective cohort study in premature children born in 1989, with a gestational age of 26 0/7 to 33 0/7 weeks. An U/C ratio>0.72 was defined as brain sparing. Behavioural problems were assessed with the parent-reported Child Behaviour Check List (CBCL) and the Teachers Report Form (TRF). T scores >60 for total problem score and subscales of internalizing and externalizing behaviour, were considered abnormal.nnnRESULTSnNinety-eight of the 116 survivors were assessed, of which 31 with antenatally established fetal brain sparing. According to the CBCL-total problem score 23.3% of the premature born babies in the brain sparing group had behavioural problems compared with 22.8% of those without brain sparing. According to the TRF-total problem score the percentages were 21.4% and 20.0%, respectively. Logistic regression analysis failed to show a significant association of U/C ratio with behavioural problems. In this model oxygen dependency at 28 days, IQ<85 at five years, cranial ultrasound abnormalities, fetal growth ratio<0.80, Apgar scores<7 after 5 min and birth weight

Difference in mother–child interaction between preterm- and term-born preschoolers with and without disabilities

Aim:u2002 To investigate differences in the quality of mother–child interaction between preterm‐ and term‐born children at age 5, and to study the association of mother–child interaction with sociodemographic characteristics and child disability.

Outcome at 4.5 years of children born after expectant management of early-onset hypertensive disorders of pregnancy

OBJECTIVEnThe objective of the study was to describe neurodevelopmental outcome at the age of 4.5 years in 216 children, born after expectant management of severe early-onset hypertensive complications of pregnancy.nnnSTUDY DESIGNnThis was a prospective follow-up study until age 4.5 years from maternal admission onward. Developmental outcome measurements included child intelligence quotient and behavioral, motor, and neurological outcome. Abnormal composite outcome (perinatal mortality or abnormal developmental outcome) was studied in relation to gestational age (GA), birthweight (BW), and perinatal variables.nnnRESULTSnFetal and neonatal mortality was 9% and 8%, respectively. Of the 178 survivors, 149 (84%) were seen for follow-up. Mean GA was 31.4 weeks and 90% were born growth restricted. Abnormal developmental outcome occurred in 20% and abnormal composite outcome in 37%.nnnCONCLUSIONnPerinatal mortality or abnormal child development occurs in one third of pregnancies with early-onset and severe hypertensive complications and is highest in the lowest GA and BW ranges.

Applying Dutch and US versions of the BSID-II in Dutch children born preterm leads to different outcomes

The aim of the present study was to evaluate whether the application of Dutch versus US test procedures and norms of the Bayley Scales of Infant Development ‐ 2nd edition (BSID‐II) leads to different developmental outcomes. The BSID‐II was administered to 376 preterm infants (191 males, 185 females; mean gestational age 30wks [SD 2.7], mean birth‐weight 1242g [SD 385]) at corrected ages of 6, 12, 24, and/or 36 months. Raw scores were calculated twice with US and Dutch test procedures. Raw scores as well as Mental Developmental Index (MDI) and Psychomotor Developmental Index (PDI) scores, calculated on the basis of Dutch versus US normative data, were compared. Small but statistically significant Dutch—US differences were found between raw scores. Large, clinically relevant Dutch—US differences were found for MDI and PDI scores, especially at 6 and 12 months. These differences were likely to have been caused by a bias in the Dutch normative data, although a slower developmental pace of Dutch children in general could also have a role. This study highlights the problems that can occur when using a test that was developed in another country, even when local standardization is available.

Parental perceptions of child vulnerability in a community- based sample: Association with chronic illness and health-related quality of life

The study aimed to assess the prevalence of parental perceptions of a child’s vulnerability (PPCV) in a Dutch community-based sample and its relationship with children’s health and health-related quality of life (HRQoL). Parents completed the Child Vulnerability Scale and a socio-demographic questionnaire. The Pediatric Quality of Life Inventory 4.0 was administered to measure HRQoL. The prevalence of PPCV was assessed in relation to socio-demographic and health-related characteristics. In a three-step multiple hierarchical regression model, the mediational role of PPCV in the association between chronic illness and HRQoL was investigated. Participants were 520 Dutch children aged 5–18 years from nine Dutch schools. In all, 69 (13.3%) had a chronic illness; 1.9% was perceived vulnerable, 3.0% in groups 5–7 and 1.7% in groups 8–12 and 13–18. Younger age of the child, presence of a chronic illness and low HRQoL were associated with PPCV. PPCV partially mediated the negative association between chronic illness and HRQoL. In conclusion, PPCV is associated with adjustment to chronic illness. More research is needed regarding the mechanisms through which PPCV affects HRQoL and to examine whether PPCV can be targeted in parenting interventions.

Perinatal risk factors for neurocognitive impairments in preschool very preterm children

Aimu2002 This study aimed to compare a broad array of neurocognitive functions (processing speed, aspects of attention, executive functioning, visual–motor coordination, and both face and emotion recognition) in very preterm and term‐born children and to identify perinatal risk factors for neurocognitive dysfunctions.

325 Attention Problems in Very Low Birth Weight Preschoolers

Aims To compare very low birth weight (VLBW) children’s performance on attention measurements at preschool age to term-born peers, and to assess associated risk factors. Methods Attention was assessed in 151 VLBW preschoolers and 41 term-born peers at 44 months of corrected age, using the Visual Attention task of the Developmental Neuropsychological Assessment, and the Gift Delay task. Parents completed the Attention Problems domain of the Child Behavior Checklist (CBCL-AP), the Inhibit domain of the Behavior Rating Inventory of Executive Function (preschool version), and the Inattention/Distractibility scale of the Sensory Profile. The investigator completed the Attention domain of the Miller Assessment for Preschoolers’ Behavior During Testing (BDT-AD). Potential perinatal and socio-demographic risk factors for attention problems were analyzed using logistic regression analysis. Results Compared with term-born peers, VLBW children scored worse on five out of six attention measurements and had significantly more abnormal scores on the CBCL-AP and BDT-AD. Analyses of BDT-AD indicate that VLBW children mostly scored abnormally on the items regarding attention maintenance. VLBW children were at higher risk for attention problems according to a composite score of significant attention problems (OR 4.6, 95% CI: 1.7–12.4). Risk factors for attention problems were having a mother born abroad (OR 3.5, CI: 1.7–7.2) and bronchopulmonary dysplasia (BPD) (OR 2.5, CI: 1.0–6.0). Conclusions At the time of school entry, VLBW children have more difficulty maintaining attention than their term-born peers. Both social and biological risk factors were predictive of attention problems. Using the CBCL-AP and BDT-AD may lead to timely intervention.