C.S.H. Aarnoudse-Moens

Motor development in very preterm and very low-birth-weight children from birth to adolescence: A meta-analysis

CONTEXT Infants who are very preterm (born < or = 32 weeks of gestation) and very low birth weight (VLBW) (weighing < or = 1500 g) are at risk for poor developmental outcomes. There is increasing evidence that very preterm birth and VLBW have a considerable effect on motor development, although findings are inconsistent. OBJECTIVE To investigate the relationship between very preterm birth and VLBW and motor development. DATA SOURCES The computerized databases EMBASE, PubMed, and Web of Knowledge were used to search for English-language peer-reviewed articles published between January 1992 and August 2009. STUDY SELECTION Studies were included if they reported motor scores of very preterm and VLBW children without congenital anomalies using 1 of 3 established and widely used motor tests: the Bayley Scales of Infant Development II (BSID-II), the Movement Assessment Battery for Children (MABC), and the Bruininks-Oseretsky Test of Motor Proficiency (BOTMP). Forty-one articles were identified, encompassing 9653 children. RESULTS In comparison with term-born peers, very preterm and VLBW children obtained significantly lower scores on all 3 motor tests: BSID-II: d = -0.88 (95% confidence interval [CI], -0.96 to -0.80; P < .001), MABC: d = -0.65 (95% CI, -0.70 to -0.60; P < .001), and BOTMP: d = -0.57 (95% CI, -0.68 to -0.46; P < .001). Whereas motor outcomes on the BSID-II show a catch-up effect in the first years of development (r = 0.50, P = .01), the results on the MABC demonstrate a nonsignificantly greater deficit with increasing age during elementary school and early adolescence (r = -0.59, P = .07). CONCLUSION Being born preterm or VLBW is associated with significant motor impairment persisting throughout childhood.

The profile of executive function in very preterm children at 4 to 12 years.

Aim  To examine executive functioning in very preterm (gestational age ≤30wks) children at 4 to 12 years of age.

Development of Preschool and Academic Skills in Children Born Very Preterm

OBJECTIVE To examine performance in preschool and academic skills in very preterm (gestational age ≤ 30 weeks) and term-born comparison children aged 4 to 12 years. STUDY DESIGN Very preterm children (n = 200; mean age, 8.2 ± 2.5 years) born between 1996 and 2004 were compared with 230 term-born children (mean age, 8.3 ± 2.3). The Dutch National Pupil Monitoring System was used to measure preschool numerical reasoning and early linguistics, and primary school simple and complex word reading, reading comprehension, spelling, and mathematics/arithmetic. With univariate analyses of variance, we assessed the effects of preterm birth on performance across grades and on grade retention. RESULTS In preschool, very preterm children performed comparably with term-born children in early linguistics, but perform more poorly (0.7 standard deviation [SD]) in numerical reasoning skills. In primary school, very preterm children scored 0.3 SD lower in complex word reading and 0.6 SD lower in mathematics/arithmetic, but performed comparably with peers in reading comprehension and spelling. They had a higher grade repeat rate (25.5%), although grade repeat did not improve their academic skills. CONCLUSIONS Very preterm children do well in early linguistics, reading comprehension, and spelling, but have clinically significant deficits in numerical reasoning skills and mathematics/arithmetic, which persist with time.

Inhibitory Performance, Response Speed, Intraindividual Variability, and Response Accuracy in ADHD

OBJECTIVE To determine the potential of inhibitory performance, response speed, and response accuracy and variability, measures central to the conceptualization of attention-deficit/hyperactivity disorder (ADHD), in distinguishing children with ADHD from healthy controls (HCs). METHOD The stop signal paradigm was administered to 38 children with ADHD and 31 NCs. The stop signal reaction time (SSRT), mean reaction time (MRT), intraindividual coefficient of variation (ICV), and number of errors were used to predict diagnostic status. RESULTS Univariate tests showed that the ADHD group performed worse than NCs on all of the dependent variables. Exploratory univariate analyses showed that oppositional defiant disorder comorbidity and ADHD type did not influence results except for the ICV, the effect for this variable (more variability in the ADHD group) being less pronounced for the Predominantly Inattentive type than for the Hyperactive-Impulsive and Combined types. A logistic regression model of the MRT, ICV, and number of errors combined showed best predictive performance, with the MRT contributing the most to group classification (56% of the variance). The final model (MRT, ICV, and number of errors) predicted 87% of the sample in the correct diagnostic category. Operating characteristics showed excellent sensitivity and specificity of 89.5% and 83.9%, respectively. CONCLUSIONS Our results contrast with theoretical accounts emphasizing inhibitory control as the pivotal measure characterizing cognitive performance in ADHD. Results are discussed in the context of a delay aversion perspective of ADHD.

Neonatal and parental predictors of executive function in very preterm children

To examine neonatal and parental predictors of executive function in very preterm (gestational age ≤30 weeks) children aged 4.0–12.0 years.

Academic performance of children born preterm: a meta-analysis and meta-regression

Background Advances in neonatal healthcare have resulted in decreased mortality after preterm birth but have not led to parallel decreases in morbidity. Academic performance provides insight in the outcomes and specific difficulties and needs of preterm children. Objective To study academic performance in preterm children born in the antenatal steroids and surfactant era and possible moderating effects of perinatal and demographic factors. Design PubMed, Web of Science and PsycINFO were searched for peer-reviewed articles. Cohort studies with a full-term control group reporting standardised academic performance scores of preterm children (<37 weeks of gestation) at age 5 years or older and born in the antenatal steroids and surfactant era were included. Academic test scores and special educational needs of preterm and full-term children were analysed using random effects meta-analysis. Random effects meta-regressions were performed to explore the predictive role of perinatal and demographic factors for between-study variance in effect sizes. Results The 17 eligible studies included 2390 preterm children and 1549 controls. Preterm children scored 0.71 SD below full-term peers on arithmetic (p<0.001), 0.44 and 0.52 SD lower on reading and spelling (p<0.001) and were 2.85 times more likely to receive special educational assistance (95% CI 2.12 to 3.84, p<0.001). Bronchopulmonarydysplasia explained 44% of the variance in academic performance (p=0.006). Conclusion Preterm children born in the antenatal steroids and surfactant era show considerable academic difficulties. Preterm children with bronchopulmonarydysplasia are at particular risk for poor academic outcome.

Very preterm born children at early school age: Healthcare therapies and educational provisions

AIM To explore changes in motor and cognitive outcomes in very preterm (VP; gestational age<30weeks) born children between ages five and six years, and to determine whether changes in these outcomes were associated with the use of healthcare therapies and educational provisions. STUDY DESIGN Single-center observational cohort study. Five-year-old VP born children of a one-year-cohort of our neonatal follow-up program (N=90) were invited for re-assessments at age six. Use of healthcare therapies and educational provisions was registered at ages five and six years. Motor function (Movement Assessment Battery for Children-2 [M-ABC-2]; higher scores indicate better functioning) and IQ (Wechsler Preschool and Primary Scale for Intelligence [WPPSI-III-NL]) were assessed at both ages. RESULTS Sixty-four VP born children were seen at ages five and at six years. In this year, 61% received healthcare therapies and/or educational provisions. M-ABC-2 scores of VP born children who received healthcare therapy and/or educational provisions were significantly higher (M=8.9 [SD=3.2]) at age six years than at age five years (M=7.5 [SD=3.3]); p<0.00). M-ABC-2 scores remained stable in the average range in VP born children without any support. IQ scores remained stable irrespective of received support. CONCLUSIONS Improvements in motor outcomes are associated with the use of healthcare therapies and/or educational support between ages five and six years in VP born children. Future studies need to determine the efficacy of existing interventions, and to develop tailored interventions to support VP born children in the transfer period from preschool to primary education.

Fetal Growth Restriction with Brain Sparing: Neurocognitive and Behavioral Outcomes at 12 Years of Age

Objective To study neurocognitive functions and behavior in children with a history of fetal growth restriction (FGR) with brain sparing. We hypothesized that children with FGR would have poorer outcomes on these domains. Study design Subjects were 12‐year‐old children with a history of FGR born to mothers with severe early‐onset hypertensive pregnancy disorders (n = 96) compared with a normal functioning full term comparison group with a birth weight ≥2500 g (n = 32). Outcome measures were neurocognitive outcomes (ie, intelligence quotient, executive function, attention) and behavior. Results For the FGR group, the mean ratio of the pulsatility index for the umbilical artery/middle cerebral artery (UC‐ratio = severity of brain sparing) was 1.42 ± 0.69. The mean gestational age was 31–6/7 ± 2–2/7 weeks. The mean birth weight was 1341 ± 454 g, and the mean birth weight ratio 0.68 ± 0.12. Neurocognitive outcomes were comparable between groups. Parents of children with FGR reported more social problems (mean T‐score 56.6 ± 7.7; comparison 52.3 ± 4.3, P < .001, effect size = 1, 95% CI 0.52–1.46) and attention problems (mean T‐score 57.3 ± 6.9; comparison 53.6 ± 4.2, P = .004, effect size = 0.88, 95% CI 0.42–1.33). UC‐ratio was not associated with any of the outcomes, but low parental education and lower birth weight ratio were. Conclusions In this prospective follow‐up study of 12‐year‐old children with a history of FGR and confirmed brain sparing, neurocognitive functions were comparable with the comparison group, but parent‐reported social and attention problem scores were increased.

Executive Function Computerized Training in Very Preterm-Born Children: A Pilot Study

OBJECTIVE Attention problems are one of the most pronounced and documented consequences of very preterm birth (gestational age ≤32 weeks). However, up to now, there is no research published on suitable interventions at school age aimed to overcome these problems. Research in this population did show that executive functions (EFs) are strongly associated with inattention. BrainGame Brian is a newly developed computerized training, in which, in 25 training sessions, the core EFs, including working memory, impulse control, and cognitive flexibility, are trained. This pilot study aimed to examine the feasibility of studying BrainGame Brian in very preterm-born children with attention problems. DESIGN Pilot feasibility intervention study with one baseline and one follow-up assessment. MATERIALS AND METHODS Feasibility was measured by the participation rate, dropout rate, and user experiences with regard to effort, training characteristics, and recommendation to others. From a larger cohort study, 15 very preterm-born children at age 10 years with parent-reported attention problems on the Child Behavior Checklist/6-18 years were invited to participate in this pilot study. BrainGame Brian was performed for a period of 6 weeks. Training outcome measures included visual working memory, impulse control, cognitive flexibility, speed variability, and parent-rated attention, for which pre- and post-training differences were examined at the group level by the Wilcoxon signed-rank test as well as for each individual child separately by the reliable change index. RESULTS Twelve of 15 children and their parents agreed to participate and 11 children successfully completed BrainGame Brian in the 6-week period. Parents were positive about training characteristics and lack of interference with schooling, but scored the effort as high. We found clinically significant changes in visual working memory and speed variability in post-training assessments. CONCLUSION BrainGame Brian is a feasible intervention for very preterm-born children with attention problems.

Multilingualism was associated with lower cognitive outcomes in children who were born very and extremely preterm

This study determined whether cognitive outcomes differed between very preterm (VPT) and extremely preterm (EPT) children who were monolingual or multilingual when they reached the corrected ages of two and five years.