Elaine A. Kelly

Cognition, academic progress, behavior and self-concept at 14 years of very low birth weight children.

The aim of this study was to compare cognition, academic progress, behavior, and self-concept children of very low birth weight (VLBW, birth weight < 1501 g) born in the period 1980 to 1982 with randomly selected children of normal birth weight (NBW, birth weight > 2499 g). At 14 years of age, 130 (84.4%) of 154 VLBW and 42 (70.0%) of 60 NBW children were assessed. Ten VLBW children and one NBW child who had cerebral palsy were excluded. VLBW children scored at a significantly lower level on all three composite scales of the Wechsler Intelligence Scale for Children, 3rd Edition. VLBW children were also significantly disadvantaged on more specific cognitive processes, including tests of visual processing and visual memory and on subtests reflecting learning and problem solving. Only in arithmetic was a difference between the groups discerned on tests of achievement. Significantly more VLBW children were rated by teachers as socially rejected and by their parents as having learning problems at school. VLBW children had significantly reduced self-esteem. VLBW children had more cognitive, academic, and behavioral problems and lower self-esteem at 14 years of age than NBW control subjects.

Children followed with difficulty: How do they differ?

Objective: To determine if very low birthweight children followed with ease differ in any perinatal or sociodemographic characteristics, or outcomes, compared with children followed with more difficulty.

Cognition, school performance, and behavior in very low birth weight and normal birth weight children at 8 years of age: a longitudinal study

ABSTRACT. Cognition, school performance, and behavior were assessed at 8 years of age in 132 very low birth weight (VLBW) children free of major sensorineural impairments, and the results were contrasted with a randomly selected control group of normal birth weight (NBW) children. Considering their fragile beginnings, the majority of VLBW children were developing normally and were reading and performing in most academic and social areas as well as the NBW children. However, VLBW children were significantly inferior to NBW children on tests of cognition, including tests of intelligence and visual memory, and on teachers reports of motor skills and initiative. In addition, proportionally more VLBW children (20.5%) than NBW children (5.9%) were reported by their parents to be not coping at school. J Dev Behav Pediatr 14:363–368, 1993. Index terms: very low birth weight, cognition, behavior.

Antenatal Corticosteroids and Outcome at 14 Years of Age in Children With Birth Weight Less Than 1501 Grams

Objective. To determine whether exposure to antenatal corticosteroid therapy was associated with adverse effects on growth, sensorineural outcome, or lung function of children of birth weight <1501 g at 14 years of age. Design. Cohort study. Setting. The Royal Womens Hospital, Melbourne, Australia. Subjects. One hundred fifty-four consecutive survivors born from October 1, 1980 to March 31, 1982. Interventions. The mothers of 78 survivors (51%) had been given corticosteroids antenatally to accelerate fetal lung maturation. Treatment with antenatal corticosteroids was nonrandom. No mother received >1 course of corticosteroids. Outcome Measures. The children were assessed at 14 years of age, corrected for prematurity. All assessors were unaware of the exposure of the child to antenatal corticosteroids. The assessments included measurements of growth and neurological, cognitive, and lung function. Growth measurements were converted into zscores (standard deviation) for the appropriate age and gender. Results. Of the 154 survivors, 130 (84%) were assessed at 14 years of age. Overall, the children exposed to antenatal corticosteroids were significantly taller (height zscore; mean difference: .39; 95% confidence interval: .001–.79) and had better cognitive functioning (Wechsler Intelligence Scale for Children-Third Edition Full Scale; IQ mean difference: 6.2; 95% confidence interval: .8–11.6) than those not exposed to corticosteroids. There were no other differences in sensorineural outcomes between the groups. Lung function was not significantly different between the groups. No conclusions were altered by adjustment for confounding variables. Conclusions. Exposure to 1 course of antenatal corticosteroid therapy was associated with some clinically and statistically improved outcomes at 14 years of age in children of birth weight <1501 g, with no obvious adverse effects on growth or on sensorineural, cognitive, or lung function. corticosteroids, growth, cognitive, IQ, lung function, adolescence.

Correction of developmental and intelligence test scores for premature birth

Abstract When using tests of infant development and intelligence in children born prematurely, the subjects age is commonly corrected for the degree of prematurity. However, there is disagreement: first, on whether this correction should ever be applied, and second, at what age to discontinue the adjustment.

Auditory function at 14 years of age of very-low-birthweight children

The aim of the study was to determine audiological function at 14 years of age of very-low-birthweight (VLBW < or = 1500 g) children compared with a cohort of normal birthweight (NBW > 2499 g) children. Participants were consecutive surviving preterm children of birthweight < 1000 g born between 1977 and 1982 (n=86) and of birthweight 1000 to 1500 g born between 1980 and 1982 (n=124) and randomly selected NBW children born between 1981 and 1982 (n=60). Audiometric tests included pure tone audiometry, tympanometry, stapedius muscle reflexes, and measures of central auditory processing. Psychometric tests included measures of IQ, academic achievement, and behaviour. There were no significant differences in rates of hearing impairment, abnormal tympanograms, figure-ground problems, or digit recall between VLBW children and NBW control children. VLBW children had higher rates of some central auditory processing problems, which in turn were associated with poorer intellectual, academic, and behavioural progress.

Changing Outcome for Infants of Birth‐weight 500‐999g Born Outside Level 3 Centres in Victoria

Summary: The aim of this study of extremely low birth‐weight (ELBW, birth‐weight 500–999 g) infants born in Victoria was to determine the changes between 3 distinct eras; 1979‐80, 1985‐87, and 1991‐92, in the proportions who were born outside level 3 perinatal centres (outbom), the proportions of outborn infants who were transferred after birth to a level 3 neonatal unit, the survival rate for outborn infants, and sensorineural impairment and disability rates in outborn survivors. The proportion of ELBW livebirths who were outborn fell significantly over successive eras, from 30.2% (106 of 351) in 1979‐80, to 23.0% (129 of 560) in 1985‐87, and to 15.6% (67 of 429) in 1991‐92. Between 1979‐80 and 1985‐87, die proportions who were outborn fell predominantly in those of birth‐weight from 800–999 g, whereas between 1985‐87 and 1991‐92 the proportions who were outborn fell predominandy in those of birth‐weight 500–799 g. The proportions of outborn infants who were transferred after birth to a level 3 neonatal unit were similar in die 3 eras, at 49.1%, 38.0% and 41.2%, respectively. The survival rates for outborn infants were lower in each era dian for infants born in a level 3 perinatal centre. Only 1 outborn infant not transferred after birth to a level‐3 unit survived in any era. The survival rates for infants transferred after birth were similar in the first 2 eras, but rose significantly in 1991‐92 (34.6%, 36.7% and 60.7%, respectively). The rates of sensorineural impairments and disabilities in survivors fell significantly between die first 2 eras, and remained low in the last era. It is pleasing that the proportion of tiny babies who were outborn fell significantly over time, reflecting increased referral of high‐risk mothers to level 3 perinatal centres before birth. For ELBW outborn infants, survival prospects free of substantial disability are reasonable, but not as good as for those born in level 3 perinatal centres.

Methylxanthines and sensorineural outcome at 14 years in children < 1501 g birthweight

Objectives: Methylxanthines, including theophylline, have been used extensively and successfully to treat apnoea in preterm infants. However, long‐term consequences of such therapy are largely unknown. The aim of this study was to determine the relationship between theophylline therapy and outcome at 14 years of age in surviving preterm children of birthweight < 1501 g.

Selective improvement in cognitive test scores of extremely low birthweight infants aged between 2 and 5 years

Abstract The cognitive development at 2 and 5 years of a cohort of extremely low birthweight (ELBW) children (birthweight 500‐999 g) was compared with that of cohorts of larger very low birthweight (VLBW) children (birthweight 1000‐1500 g) and normal birthweight (NBW) children (birthweight > 2500 g) to determine whether the improvements in cognitive function of ELBW infants between 2 and 5 years are apparent or real.

Outcome to 8 years of infants <1000 g birthweight: Relationship with neonatal ventilator and oxygen therapy

The study involved a cohort of 59 consecutive survivors with birthweights < 1000 g, born between 1977 and 1980, to 8 years of age. The aim of the report was to determine if those survivors who had received more oxygen and ventilator therapy differed in their outcome compared with those who had received less oxygen and ventilation. Children were graded into four groups, characterized by decreasing durations of oxygen and ventilation. Children who had received less oxygen and ventilation were more likely to be below the third percentile for weight at 2, 5 and 8 years but the trends were significant only at 2 and 5 years (P= 0.006, P= 0.013 and P= 0.19 respectively). The rate of cerebral palsy was 8% at 8 years; the only children with severe or moderate disabilities from their cerebral palsy were in the lowest oxygen and ventilation group (n= 4, P <0.02). The frequency of hospital re‐admission and the duration of re‐hospitalization did not vary significantly between the four groups at any age. The rates of recurrent wheezing episodes or asthma did not vary significantly between the groups. Although the cohort as a whole had some impairment of lung function compared with healthy full‐term controls, there was no significant difference between the four groups. Contrary to expectations, our findings suggest lower rates of poor growth and adverse neurological outcomes with increasing durations of oxygen and ventilation in the newborn period.