Dianne E. Creighton

Neurocognitive, Functional, and Health Outcomes at 5 Years of Age for Children After Complex Cardiac Surgery at 6 Weeks of Age or Younger

OBJECTIVE. This work provides neurocognitive, functional, and health outcomes for 5-year survivors of early infant complex cardiac surgery, including those with chromosomal abnormalities. PATIENTS AND METHODS. Of 85 children (22.4% mortality), 61 received multidisciplinary, individual evaluation and parental questionnaires at 5 years. Full-scale, verbal, and performance IQ scores were compared by using analysis of variance among children who received different surgeries (arterial switch, 20; Norwood for hypoplastic left heart syndrome, 14; simple total anomalous pulmonary venous connection, 6; miscellaneous, 21; and chromosomal abnormalities, 8). Predictions from mental scores at 2 years for IQ scores at 5 years were determined. RESULTS. Children with chromosomal abnormalities had lower full-scale and verbal IQs at 5 years than other survivors, with no differences found among the remaining groups. For children post-Norwood, performance IQ scores remained lower than for children after the arterial-switch operation. Prediction of full-scale IQ (<70) from 2-year mental scores for all 61 children were as follows: sensitivity, 87.5%; specificity, 88.1%; positive predictive value, 53.8%; and negative predictive value, 97.9%. For full-scale IQ of <85, predictions were 90.0%, 87.8%, 78.3%, and 94.7%, respectively. For those 53 without chromosomal abnormalities, full-scale IQ <70, respective predictions were 86.7%, 90.0%, 28.6%, and 97.8%, and for full-scale IQ <85, respective predictions were 85.7%, 89.7%, 75.0%, and 94.6%. Parental report indicated good health in 80% and adequate function in 67% to 88% of the children, although health-utilization numbers suggest that these reports are optimistic. CONCLUSIONS. Five-year full-scale and verbal IQs were similar among groups, excluding those with chromosomal abnormalities. Children with chromosomal abnormalities had the lowest scores. Excluding those with chromosomal abnormalities, the mean mental scores for the children as a group tended to increase from 2 to 5 years of age, with an overall high percentage of correct classifications at 2 years.

Overestimating Neurodevelopment Using the Bayley-III After Early Complex Cardiac Surgery

BACKGROUND: The newest measure of neurodevelopmental outcomes, the Bayley Scales of Infant and Toddler Development, 3rd Edition (Bayley-III), gives higher-than-expected scores for preterm infants; results after cardiac surgery are unknown. OBJECTIVES: The goal of this study was to report Bayley-III scores after cardiac surgery and compare the results with those of the Bayley Scales of Infant Development, 2nd Edition (BSID-II) on a subset of the same children. METHODS: In this prospective, inception cohort, neurodevelopmental outcome study after complex cardiac surgery in infants from 2004 to 2007, the Bayley-III was given to 110 survivors (68% boys) at a mean age of 21 months (SD: 4 months). Analysis of variance was used to compare intergroup differences. Results for both test editions on the same 25 children were compared by using paired-samples statistics. RESULTS: Mean (SD) Bayley-III mean composite scores (CSs) for 110 children were as follows: cognitive, 95.9 (14.1); language, 90.8 (18.1); and motor, 93.7 (14.2), differentiating selected cardiac surgery groups. The average difference in mean CSs was 7.4 points higher than BSID-II scores for a previous cohort from this site and 7.2 points higher than a systematic review report. Direct comparison of BSID-II and Bayley-III revealed an average difference in mean CSs of 6.1 points, similar to normative results. Mean cognitive CSs increased by 10.0 (P <.001), language by 1.4 (P = .526), and motor by 6.9 points (P = .009). CONCLUSIONS: Researchers should be careful attributing higher Bayley-III scores to changes in acute care. At-risk children who previously qualified for early developmental intervention may no longer do so. School-age longitudinal studies are needed to determine the accuracy of early developmental estimates using the Bayley-III.

Neurodevelopmental outcome following exposure to sedative and analgesic drugs for complex cardiac surgery in infancy

Objectives/Aim:  To determine whether sedation/analgesia drugs used before, during, and after infant cardiac surgery are associated with neurodevelopmental outcome.

Neurotoxicity of sedative and analgesia drugs in young infants with congenital heart disease: 4-year follow-up.

To determine whether sedation/analgesia drugs used before, during, and after infant cardiac surgery are associated with neurocognitive and functional outcomes.

Assessment of Developmental Coordination Disorder in Children Born With Extremely Low Birth Weights

There is no tool that is considered the “gold” standard for identifying children with developmental coordination disorder (DCD) and various techniques have been reported in the research literature. The aim of this study was to examine the prevalence of DCD in a cohort of extremely low birth weight (ELBW; birth weight ≤ 1,000g) children at age 5 years using various methods including standardized motor assessment measures, an established clinic protocol, and a parent report. We also examined the association between selected neonatal risk factors and severity of the motor impairment. Four methods were used to assess motor functioning: (1) the Movement Assessment Battery for Children (Movement ABC); (2) a motor assessment battery, which included the Movement ABC, the Beery-Buktenica Developmental Test of Visual Motor Integration, and the Developmental Test of Visual Perception–2; (3) a Perinatal Follow-up Clinic protocol, which included the Geometric Design and the Mazes subtests of the Wechsler Preschool and Primary Scale of Intelligence–Revised, the Fine and Gross Motor subscales of the Child Development Inventory, and a pediatric neuromotor exam; and (4) a parent completed questionnaire (i.e., Developmental Coordination Disorder Questionnaire (DCDQ)). The prevalence of motor impairment in ELBW children was 64% on the Movement ABC, 67% on the motor assessment battery, 66% on the Perinatal Follow-up Clinic protocol, and 26% on the DCDQ. Sensitivity ranged from 36% to 100% and specificity from 65% to 92% using the Movement ABC as the reference standard. Neonatal risk factors associated with increased severity of motor impairment were bronchopulmonary dysplasia, postnatal steroids, and increasing gestational age. Children with birth weights ≤1,000 g are at considerable risk for motor impairment; therefore, developmental evaluations should include an assessment of motor functions. A standardized motor assessment test such as the Movement ABC appears to be the most effective and efficient means of identifying motor impairment in this high-risk population.

Vocal Development of Infants with Very Low Birth Weight.

This study describes the vocal development of infants born with very low birth weights (VLBW). Samples of vocalizations were recorded from three groups of infants when they were 8, 12 and 18 months of age: preterm VLBW infants with bronchopulmonary dysplasia (BPD), preterm VLBW infants without BPD, and healthy full‐term infants. Infants with BPD produced significantly smaller canonical syllable ratios than the full‐term infants throughout the period of study. Premature VLBW infants who did not suffer from BPD produced relatively little canonical babble at 8 months of age, but were performing within the range of the full‐term infants at 18 months of age. At 18 months of age, the infants with BPD were reported to have significantly smaller expressive vocabulary sizes than the healthier preterm and full‐term infants.

Hearing and verbal-cognitive abilities in high-risk preterm infants prone to otitis media with effusion.

Preterm infants with a history of perinatal complications are at risk for language learning difficulties, and are more likely than full-term infants to show recurrent otitis media. The present study looks at the association between these risk outcomes in the preschool period. Twenty-three otitis-prone preterm children (referred to as cases) were compared with 20 non-otitis-prone children with similar perinatal and demographic characteristics (controls). Hearing thresholds were depressed for the cases in conjunction with abnormal tympanograms, and hearing was significantly poorer than for controls. Some language and verbal cognitive abilities were significantly poorer for the cases. The findings suggest the importance of medical intervention, audiometric assessment, and speech and language follow-up for high-risk premature infants prone to otitis media with effusion.

Sex differences in the visual habituation of 4-, 6- and 8-month-old infants

Forty infants were tested in a subject-controlled habituation paradigm at 4, 6, and 8 months. Checkerboards varying in complexity were presented for 16 trials, preceded and followed by the presentation of control stimuli. Analyses of fixation durations and latencies were performed in replication of the methods of Cohen (1973) . Although Cohens findings on sex differences in 4-month habituation behavior were not reproduced, his model of infant memory was useful in interpreting the sex differences obtained.

Early indicators of learning problems in high-risk children.

The study examined the association between transient neurologic abnormalities and later learning problems in children who experienced perinatal difficulties. Follow-up assessments at school age were made of children from a Perinatal Follow-up Program who had birth weights <1500 g, or required assisted ventilation, or experienced seizures in the neonatal period. Eighteen children who had shown abnormalities on Amiel-Tison Neurologic Exam between 4 and 18 months of age, but assessed as developing normally on neuromotor and cognitive assessments by 24-48 months, were identified as cases. These cases were compared with 29 controls who had been assessed as normally developing throughout. No significant group differences were found on school-age cognitive, language, visual-motor, school performance, or behavior measures. Significant correlations between perinatal and demographic variables and school-age measures were found. A sizable number of these high-risk children were shown to have signs of school-related problems. J Dev Behav Pediatr 11:1-6, 1990.

Psychometric Properties of the Canadian Little Developmental Coordination Disorder Questionnaire for Preschool Children

ABSTRACT Aims: Test the psychometric properties and cut-off scores for the Canadian Little Developmental Coordination Disorder Questionnaire (Little DCDQ), which screens for coordination difficulties in children aged 3 to 4 years. Methods: Parents of children with typical development (n = 108) and children at risk for motor problems (n = 245) completed the questionnaire. A subgroup (n = 119) of children was tested with the Movement Assessment Battery for Children-2 (MABC-2) and the Beery–Buktenica Developmental Test of visual-motor integration (VMI) to determine motor impairment (MI). Results: Test-retest reliability (r = 0.956, p < .001) and internal consistency (Cronbachs alpha = 0.94) were high. Construct validity was supported by a factor analysis and significant difference in scores of children who were typically developing and were at risk. Concurrent validity was evaluated for the children who received standardized motor testing, with significant difference between children with and without MI. Discriminant function analysis showed that all 15 items were able to distinguish the two groups. The questionnaire correlated well with the MABC-2 and VMI. Validity as a screening tool was assessed using logistic regression modeling (X2(5) = 25.87, p < .001) and receiver operating curves, establishing optimal cut-off values with adequate sensitivity. Conclusions: The Little DCDQ is a reliable, valid instrument for early identification of children with motor difficulties.