Elizabeth M. Bryan

Coordination in Low Birthweight Seven-Year-Olds

ABSTRACT. The coordination and laterality of a group of 171 seven‐year‐old children, free from major disability, with a birthweight of 2000 g or less, were examined and compared with those of normal birthweight peers. More low birthweight children were left‐handed and of mixed or undetermined hand, foot and eye dominance. Left‐handedness may adversely affect some areas of performance of normal birthweight but not of low birthweight children. Low birthweight children performed significantly less well in tests of both fine and gross motor coordination. Girls tended to perform better than boys in fine motor tests. In the low birthweight group there was a correlation between IQ and coordination.

IgG deficiency in association with placental oedema.

Deficiency of the immunoglobulin C (IgG) in the human newborn is rare in the absence of maternal hypogammaglobulinaemia. Low concentrations of IgG in cord blood were found in 3 conditions--the donor twin in the fetofetal transfusion syndrome, hydrops fetalis and congenital hepatic disease. These were all associated with placental oedema. It is suggested that the oedema may be responsible for a disturbance in maternofetal placental transfer.

Benign Fetal Ascites Associated with Maternal Polyhydramnios: A Report of Transitory Ascites in Two Newborn Infants:

Two cases of transitory ascites in the newborn period associated with maternal polyhydramnios are described. No predisposing cause was found in either infant but the possibility of an abnormality in the fetal circulation is suggested.

Congenital Syphilis A Study of Physical and Biochemical Aspects

Twenty-three infants who had positive cord blood VDRL test results are described. Fourteen had clinical signs of congenital syphilis. All but one of the affected, and only one of the unaffected infants had high immunoglobulin M (IgM) levels. Several affected infants had low immunoglobulin G (IgG) levels suggesting poor placental transfer. Total protein, albumin and colloid osmotic pressure (COP) levels were generally within the normal range in the whole group, so these are unlikely to be responsible for the neonatal edema found in many of the affected infants.

THE DEATH OF A NEWBORN TWIN

The perinatal death of one twin may be as great a loss to the mother as that of a single baby. This is rarely appreciated. The experiences and needs of a sample of 14 bereaved mothers of multiple births (12 twin, 2 triplet) obtained through the Twins and Multiple Births Association, were explored by semi-structured questionnaires.Results - All mothers perceived the survivor as a twin. 6 had feelings of rejection towards this child initially. Others overprotected and continued to have unjustified anxiety. The initial difficulties of simultaneously celebrating a birth and mourning a death were revived at anniversaries. All mothers had wanted to talk about the dead baby but many had been discouraged and made to feel guilty about their grief. Suppression of grief sometimes led to unresolved mourning. Some felt they had been given inadequate information and all wanted to know the twins’ zygosity. The fear of a fantasy twin was expressed by some who had no tangible reminders. Suggestions for future professional practice - Acknowledgement of the importance of the dead baby. Encouragement of mother to talk about him. Provision of counselling facilities. Provision of ultrasound scan to reduce fear of fantasy twin; of photographs of babies including, with liveborns, of both together, of zygosity determination.

DENTAL DEVELOPMENT IN LOW BIRTHWEIGHT (LBW) CHILDREN UNTIL SEVEN YEARS OF AGE

A dental study was incorporated into a follow up study of LBW children (birthweight <2000g). The aim was to compare the prevalence of enamel defects, tooth size and eruption of teeth in LBW children with normal birthweight controls. Dental examinations were performed at 3, 5, and 7 years to determine the prevalence of enamel hypoplasia. Dental casts were made at 7 years to measure deciduous tooth size. The deciduous teeth of the LBW children, were significantly (p<.001) smaller had significantly more enamel hypoplasia and erupted significantly later than controls. When age was corrected for premuaturity there was no significant difference in eruption times. More hypoplasia occurred in the deciduous teeth of the LBW children who suffered major neonatal problems. The LBW group however did not show an incresed prevalence of hypoplasia in the permanent teeth. It is suggested that as the deciduous teeth calcify both pre and postnatally a systemic upset during the neonatal period disturbs the enamel forming at that time, whereas the permanent teeth do not start to calcify until around birth and, particularly in a premature child, may escape this insult.

54 SCHOOL PERFOMANCE OF LOW BIRTHWEIGHT CHILDREN

Standardised tests of mental and psychomotor development were administered to 175 low birthweight (LBW) children (bw<2000g) at a mean age of 7.1 years. WISC IQ scores were within the average range X 101) as were Neale reading profiles X 7.4 years). Errors on the Bender-Gestalt were average (5) but drawing was relatively immature (38%). Multiple regression statistics indicated that social class was the main predictor for intellectual performance. However, drawing was significantly poorer in small for gestational age children (p<.002) and visuo-motor errors were more likely in those with a BW less than 1500 grams (p<.003). Severity of neonatal illness was a significant predictor for poor drawing skills (p<.03), perceptual-motor errors (p<.002), and limited concentration (p<.04) and persistence (p<.01). These results support the findings of others that the major deteriainant of academic achievement is parental background. However, neonatal factors do have a significant impact on abilities which are fundamental to essential basic skill (e.g. handwriting) and the processing on new information (e.g. attention).

38 HAND EYE COORDINATION IN 7-YEAR OLD LOW BIRTHWEIGHT CHILDREN

As part of a larger study, hand-eye coordination was measured in a group of low birthweight (LBW) (BW2000g) 7 year olds attending normal school, and a control group of normal birth-weight children selected from local schools. Children with cerebral palsy were excluded. The distribution of sex, social class and race was similar in the two groups but there were significantly more first surviving and only children in the LBW group (p<.005). LBW children were less good at finger-nose pointing (p<.01), diadochokinesis (p≪.001) and finger opposition using both hands simultaneously (p<.05). There was no significant difference in the ability to throw a ball up and catch it, but LBW children were less able to clap while the ball was in the air (p<.001). Within the LBW group there was no significant difference between children of different birth weight, sex or gestation, but children who were appropriate for gestational age (AGA) were better at diadochokinesis than those who were small for gestational age (p<.05). These findings show that LBW children are less good at hand-eye coordination than children of normal birthweight*

55 ENAMEL DEFECTS IN LOW BIRTHWEIGHT CHILDREN WITH NEONATAL PROBLEMS: A HISTOLOGICAL STUDY

A clinical study has shown that low birth weight (LBW) children (≤2kg) had significantly more enamel defects of their deciduous dentition than normal birthweight controls. There was an increased prevalence in children who had severe neonatal problems, or a 1 min Apgar of <4 irrespective of whether or not they had subsequent illness (p<.001). In a follow up histological study, 100 μm sections of deciduous incisors were examined with light and polarization microscopy. LBW children often had a more marked neonatal incremental line in enamel than the controls. Defects were seen corresponding to enamel formation at the time of stress to the infant, but later enamel formation was normal as the child recovered and the insult to the developing tooth was removed. By studying dental tissues fran these LBW children with well documented perinatal histories it is hoped to determine the value of deciduous teeth as a potential tool for studying disturbances of general growth and development during this period.

HEAD NARROWING IN PRETERM INFANTS

The marked narrowing of the head which develops in many preterm infants often causes concern to their parents, who may worry that the unusual shape will persist or that it may be associated with intracranial pathology and developmental delay. The biparietal (BP) and anteroposterior (AP) diameters were measured weekly in 203 preterm infants during their stay in NICU, and at regular intervals up to three years of age. The AP/BP ratio was calculated (Baum J D and Searls D, Dev Med and Child Neurol. 1971 13: 576-581). This ratio rose from a mean of 1.36 in the first week to a mean of 1.48 at six weeks and fell to a mean of 1.42 by 13 weeks. Less mature babies and those with lower birth weights showed more flattening but this was not statistically significant. The presence of intracranial pathology detected by ultrasound did not affect head shape. 11% of babies showed marked early flattening (AP/BP ratio 1.55). These were compared with the rest of the group. At three years there was no significant difference in AP/BP ratio or in Griffiths Development Quotient. We conclude that by the age of 3 years the babies showing very marked early head flattening did not differ from the rest of the cohort in the areas examined.(NICU = Neonatal Intensive Care Unit)