Cecelia McCarton

A simple estimate of glomerular filtration rate in low birth weight infants during the first year of life: Noninvasive assessment of body composition and growth

The management of the preterm infant often requires rapid assessment of glomerular filtration rate (GFR). We sought to develop a screening test using GFR = kL/Pcr, where GFR is expressed as ml/min/1.73 m2, L is body length in centimeters, Pcr is plasma creatinine concentration, and k is a constant that depends on muscle mass. The value for k in 118 appropriate for gestational age preterm infants (0.34 +/- 0.01 SE) was significantly less than that of full-term infants (0.43 +/- 0.02, P less than 0.001). There was no difference between 12- to 24-hour single-injection inulin clearance and either 0.33 L/Pcr or creatinine clearance in preterm infants. We compared the body habitus of preterm and full-term infants using the assessment of muscle mass from urinary creatinine excretion (UcrV) and from upper arm muscle area (AMA) and volume (AMV), and that of fatness from the sum of five skinfold thickness measurements. During the first year of life, premature infants were found to have a lower percentage of muscle mass than term infants did. On the other hand, they took on a relatively greater amount of subcutaneous fat. There was a very good correlation between AMA or AMV and urinary creatinine excretion (r = 0.91 and 0.94, respectively) in 68 infants with heterogeneous body composition during the first year, indicating the validity of the urinary creatinine measurement. Absolute GFR (ml/min) was also well estimated from AMA or AMV factored by Pcr. We conclude that GFR can be well estimated from 0.33 L/Pcr in preterm infants. The lower value for k reflects the smaller percentage of muscle mass in preterm versus term infants. As a screening test, 1.5 X k or 0.05 L/Pcr predicted low values of GFR with an efficiency of 73%, specificity of 67%, and sensitivity of 88%.

Early educational intervention for very low birth weight infants: results from the Infant Health and Development Program.

OBJECTIVE To examine the effect of early educational intervention after discharge from the hospital on the health and developmental status of very low birth weight (< or = 1500 gm) infants. DESIGN Randomized, controlled trial, with post hoc analysis. SETTING Eight sites, heterogeneous for sociodemographic and health care use. PARTICIPANTS Infants (N = 280) born weighing < or = 1500 gm and selected for the Infant Health and Development Program. Eligibility was limited primarily by geographic distance from the day care center. One third were randomly assigned to the intervention (INT) group and two thirds to follow-up only. INTERVENTIONS All children received intensive pediatric and developmental surveillance. The INT group received home visits and center-based educational interventions until 36 months of age (corrected for gestational age when final assessments were completed). OUTCOMES Cognitive development (Stanford-Binet Intelligence Scale), behavioral competence (Achebach Child Behavior Checklist), and health status (indexes summarizing reported morbidity, the Functional Status II (R) Scale, and General Health Ratings Index). RESULTS Cognitive development scores were 7.2 points higher (p = 0.002) in the INT group, after adjustment for baseline differences in site, sociodemographic characteristics, and neonatal morbidity, and were 9.4 points higher (p < 0.0003) when the 29 children with significant cerebral palsy were removed. No differences in behavior, serious morbidity, functional status, or health rating were found overall. The infants in the INT group who weighted < or = 1000 gm at birth had significantly lower behavior problem scores but no differences on other outcomes. All children in the INT group had slightly higher rates of less serious morbidity. CONCLUSION The advantage conferred by being in the INT group, as previously reported for heavier infants, extends to very low birth weight children, supporting the use of early intervention in this group.

Information Processing at 1 Year: Relation to Birth Status and Developmental Outcome during the First 5 Years.

As part of a longitudinal study of high-risk preterm infants (birthweight less than 1500 g) and a low socioeconomic status (SES) comparison group of full-term infants, measures of information processing were obtained at 1 year : visual and tactual recognition memory, cross-modal transfer, and object permanence. Of these, cross-modal transfer was the most strongly related to later intelligence, correlating with outcome at 1.5, 2, 3, 4, and 5 years for preterms and from 3-5 years for full-terms (rs=44 to 54) ; relations with outcome were independent of SES, maternal education, medical risk, and early Bayley scores. When this 1-year measure of cross-modal transfer was combined with 7-month visual recognition memory, 35%-51% of the variance in 3-,4-, and 5-year IQ was explained

Otitis media, auditory sensitivity, and language outcomes at one year†‡

The relationship among otitis media, auditory sensitivity, and emerging language was examined in a group of 1‐year‐old children who were prospectively followed since birth. Pneumatic otoscopy was used to document the otologic status of the childrens ears at each medical visit. There were 13 babies with normal ratings in each ear at 80% more of their visits (designated as “otitis free”) and 12 babies with bilaterally positive otoscopy results at 30% or more of their first year visits (designated “otitis positive”). In comparison to the otitis free infants, the group of otitis positive babies demonstrated reduced auditory sensitivity as measured by auditory brain stem response (ABR) and poorer expressive language abilities. However, differences in receptive language were not detected. These results suggest that otitis media may have an impact on auditory sensitivity and developing language as early as 1 year of age.

Health care use of 3-year-old low birth weight premature children: Effects of family and neighborhood poverty☆☆☆★★★

OBJECTIVE The objective of this study was to examine the effect of family and neighborhood income on health care use of young children born prematurely and of low birth weight (N = 619). DESIGN A birth cohort was enrolled in a clinical randomized trial of early childhood educational and family services. SETTINGS/PARTICIPANTS Infant Health and Development Program provided a sample of low birth weight premature infants stratified by clinical site, birth weight, and treatment group. Maternal reports of health care use, family income, and heath insurance were obtained at 12, 24, and 36 months of corrected age. Neighborhood income was based on census tract residence at birth. MAIN OUTCOME MEASURES Maternal reports of hospitalizations, doctor visits, and emergency department visits were used; data were averaged over the childs first 3 years of life. RESULTS Children from poorer families were more likely to be hospitalized and to have more emergency department visits than were children from more affluent families. Residence in poor and middle-income neighborhoods was associated with more emergency department visits than residence in affluent neighborhoods. Families in middle-income neighborhoods reported more doctor visits than families in poor or affluent neighborhoods. CONCLUSION Neighborhood residence influences health care use by poor and nonpoor families and by insured and uninsured families. The use of the emergency department for low birth weight premature children in middle-income and poor neighborhoods is discussed.

Patterns of service use in preschool children : Correlates, consequences, and the role of early intervention

This article explores service use broadly by examining the mix of educational, health, and psychosocial services that preschool children received in the fifth year of life. The sample included 869 children who participated in the Infant Health and Development Program, an early intervention program designed to evaluate the efficacy of a comprehensive early intervention for low-birth-weight, premature infants during the first 3 years of life and who were followed until age 5. Cluster analyses of services at age 5 yielded 4 service groups--basic health only (doctor visits; n = 114); basic health and educational services (doctor visits and school/preschool; n = 444); basic health, educational, and psychosocial services (or multiple services; doctor visits, school/preschool, and psychosocial services; n = 129); and specialized health and educational services (doctor visits, school/preschool, emergency room visits and special medical visits [ear and/or eye examinations]; n = 182). Results suggest that neonatal health conditions, maternal education at the time of the childs birth, child developmental status at age 3, and maternal health, family income, and insurance status at age 5 were associated with patterns of services at age 5. Patterns of use are consistent over time (the first 3 years of life to the 5th year of life). After covarying the correlates of the service patterns, participation in the early intervention was not associated with patterns of services at age 5, and service patterns were associated with child well-being (health, school readiness, mental health), but results differed by intervention status. Findings are discussed in terms of preventive, responsive, and deficit models of service use.

A neonatal preventive intervention study: Issues of recruitment and retention.

Intervention to prevent negative mental health outcomes in families of ill and premature newborns is an important part of neonatal care. This study addresses the factors which influence participation in a parent support group for parents of ill and premature newborns. Demographic, social support, and infant health data were examined to determine how support group participants and nonparticipants differed. In addition, efforts at enhancing recruitment and retention into support groups were examined. Results showed participants in the support group to have less healthy infants with longer hospital stays than nonparticipants. Participants reported more favorable financial situations, slightly higher incomes and less social support as measured by fewer contacts with family and friends than nonparticipants. Recommendations for future intervention research are discussed.

Relations between infant neurobehavioral performance and cognitive outcome in very low birth weight preterm infants

The predictive utility of three aspects of neonatal neurobehavioral performance was examined in 144 very low birth weight (<1500 g) preterms who were followed until 6 years of age. Visual-following and auditory-orienting composites derived from the Einstein Neonatal Neurobehavioral Assessment Scale were modestly related to the Mental Developmental Index (MDI) and IQ scores at several ages, whereas the active motility composite was only related to MDI scores at 1 year of age (corrected). Infants who showed deviant performance on both visual following and auditory orienting composites had significantly lower cognitive test scores at 1 and 6 years of age and were more likely to be classified as subaverage at 6 years of age (IQ < 85). Group differences were independent of both neonatal health status and motor scores and were not due to the performance of children with severe sensory impairments. These findings suggest that visual following and auditory orienting measured in the neonatal period can offer a useful way of indexing initial capacities.

Early Intervention for Low-birth-weight Premature Infants: What Can We Achieve?

Low-birth-weight (LBW) premature infants are at increased risk for abnormal development. It is unclear whether intervention programs designed to prevent the disabilities in preterm children are efficacious. This paper reviews the settings in which interventions take place (e.g. nursery, home) and to whom they are directed (e.g. infant, parent). One intervention program, the Infant Health and Development Program (IHDP) is reviewed in detail. The IHDP was a multisite randomized clinical trial to evaluate the efficacy of combining developmental and support services along with paediatric follow-up to reduce the developmental problems seen among LBW preterm infants. Results from all studies suggest that preventive developmental interventions for LBW, premature infants have thus far demonstrated only modest success. Future research endeavours should investigate the type, duration, critical age onset, and intensity of the intervention as well as which subgroups of LBW infants most benefit from such programs.

Preventive interventions with low birth weight premature infants: An evaluation of their success

The outcome literature on low birthweight (LBW) premature children indicates that they are at risk for a variety of neurodevelopmental impairments throughout childhood. To prevent such disabilities, numerous interventions have been initiated with LBW children. Nineteen intervention programs designed for LBW preterms that have published study results dating from 1971 are reviewed. Included are interventions in the neonatal nursery, at home, and at centers as well as interventions that are both child-focused and parent-focused. One randomized clinical trial evaluating comprehensive intervention services, the Infant Health and Development Program, is described in detail. Conclusions from the studies reviewed indicate that intervention programs have had only modest success in altering neurodevelopmental outcomes, although parent-child interaction has often been facilitated. Future research on the effects of preventive intervention needs to examine long-term developmental competencies and to replicate positive findings in multiple settings.