Evelyn G. Lipper

Hand Preference Of Four-Year-Old Children: Its Relationship To Premature Birth And Neurodevelopmental Outcome

Information was obtained at age four years on the hand preference of 98 children who had been born prematurely with a very low birthweight and of 54 children born at term with no birth complications. Data were also collected on the hand preference of their parents. The preterm children had been assessed at age three years for IQ, expressive language, speech articulation and neurological status. A significantly lower proportion of preterm than of term children used their right hand for unimanual activities. Furthermore, those preterm children who were not right‐handed were significantly more likely to have lower IQs, expressive language delays and articulation problems. Among preterm children with IQs ≥ 85, language and speech problems were no more likely to occur in those who preferred the left hand or who used both hands than in those who preferred the right. The findings of this study support the theory that birth complications lead to cerebral insult which may alter hand preference, and at the same time affect mental and motor development.

Early predictors of one-year outcome for infants asphyxiated at birth

This study attempted to identify within the first 48 hours of life those infants sustaining hypoxic‐ischemic insults and destined to have neurodevelopmental abnormalities at one year of age. Neurological examination and cranial CT scan were quantitated to provide a post‐asphyxia score and CT low‐density index for each of 34 fullterm infants. The post‐asphyxia score and CT infarction index were used to predict infants with normal and abnormal outcomes at one year of age, and both were valuable predictors of neurodevelopmental sequelae.

Hand preference, prematurity and developmental outcome at school age.

Information was obtained on the hand preference of 88 premature and 80 matched full-term children at 7-8 years old. These children were also evaluated for neurologic status, IQ, attention-deficit hyperactivity disorder, and learning disabilities. Although the difference on hand preference was not significant, 12% more of the premature children than the full-term children were left- or mixed-handed. Results showed that, among premature children, there is an association between non-right-handedness and cognitive and behavioral deficits and that left-handed children show relative clumsiness with the non-preferred hand.

EARLY PREDICTORS OF NEURODEVELOPMENTAL OUTCOME OF VERY LOW‐BIRTHWEIGHT INFANTS AT THREE YEARS

Seventy‐nine premature infants weighing < 150 lg at birth but appropriate for gestational age underwent a H neurodevelopmental examination at one, three, six, nine and 12 months post‐term, and a standard neurological examination and the Stanford‐Binet Intelligence Scale at three to four years of age. Children were classified as normal, suspect or abnormal on the three‐year neurological examination, on the IQ test, and on composite neurodevelopmental outcome at age three years. Results showed that items from both the nine‐ and 12‐month neurodevelopmental examinations correctly classified about 80 per cent of the children as to composite outcome at three years. In addition, the 12‐month examination enabled correct prediction for 89 per cent of the children as to neurological outcome and for 82 per cent as to IQ.

Survival and outcome of infants weighing <800 grams at birth

This study reports on two aspects of outcome in a sample of infants whose birth weights ranged from 500 to 799 gm. First, maternal and early neonatal variables were analyzed by means of stepwise logistic regression. Five-minute Apgar score and initial pH were the only variables that predicted mortality at p ≤ 0.05. Second, the surviving infants were examined at ages ranging from 17 months to 7 years. The majority (72%) had neurologic and/or developmental examinations in the suspect or abnormal range and required rehabilitation or early intervention services.

Occlusive vascular disease in asphyxiated newborn infants

Six full-term severely asphyxiated newborn infants underwent evaluation with digital intravenous angiography. All infants were comatose and flaccid and had seizures, depressed brainstem function, and signs of intracranial hypertension. An initial brain CT scan revealed diffuse hypodensities and compressed ventricles. Follow-up noncontrast CT scans showed areas of increased attenuation. Digital intravenous angiography demonstrated venous sinus thrombosis in five infants, two of whom also had arterial thrombosis, and hypervascularity in the sixth infant. Our data document that occlusive vascular disease is a prominent feature of severe perinatal asphyxia.

Cognitive Abilities and Early Precursors of Learning Disabilities in Very-low-birthweight Children with Normal Intelligence and Normal Neurological Status

Fifty-nine of 88 children with birthweights ≤1500 grams had normal Full Scale IQ scores (≥80) and were judged to have normal neurological status at 7 to 8 years old. Twenty-two (37%) of these children were classified as being learning-disabled, as they had academic achievement scores ≤25th percentile. The children with learning disabilities had significantly lower Full Scale and Verbal IQ scores on the Wechsler Intelligence Scale for Children-Revised (1974), but they did not differ significantly from the normal children without learning disabilities on Performance IQ. Learning-disabled children also scored significantly lower on some tests of auditory processing and auditory memory, but not on visuo-motor abilities. Discriminant function analysis indicated that it was possible to correctly predict classification of 81% of the children as learning-disabled or not, based on measures of neonatal respiratory distress and social class level, 1-year mental and neuromotor abilities, and 3-year-old measures of language and visuo-motor integration. Results suggest that verbal deficits, rather than visuo-motor ones, underly learning disabilities at school age in prematurely born children and that these children exhibit signs of subtle neurological impairment at earlier ages.

PARENTAL NEEDS IN A NEONATAL INTENSIVE CARE FOLLOW-UP CLINIC

There has been a recent increase in the number of neonatal intensive care units. The literature suggests that premature innfants are poorly parented more frequently than full term infants. It is known that low birth weight and seriously ill infants have a higher incidence of abuse and failure-to-thrive than those born at full term. In order to provide optimal care for parents of high risk infants an attempt was made to assess what these parents perceived their needs to be. They were offered an opportunity to be a part of a parent group and/or speak to a professional on an individual basis.Sixty-one parents of infants from age 1-18 months were evaluated using a brief semi-structured interview. Results indicated that 62% of parents interviewed wanted the intervention program. A discriminant analysis was performed to determine what variables correlated with the parents desire to engage in the intervention program.Higher socio-economic status (SES) and greater severity of illness were directly correlated with parents wanting an intervention. Younger maternal age and lower SES were correlated with not wanting the intervention program.Programs designed to meet the needs of these parents should be part of the comprehensive care prescription. Other programs must be designed to reach the low SES young mother.

Fragile X syndrome in two siblings with major congenital malformations

We report on 2 brothers with both fragile X and VACTERL-H syndrome. The first sibling, age 5, had bilateral cleft lip and palate, ventricular septal defect, and a hypoplastic thumb. The second sibling, age 2 1/2, had a trachesophageal fistula, esophageal atresia, and vertebral abnormality. High-resolution chromosome analysis showed a 46, XY chromosome constitution in both siblings. By PCR and Southern blot analysis, the siblings were found to have large triplet repeat expansions in the fragile X gene (FMR 1) and both had methylation mosaicism. Enzyme kinetic studies of iduronate sulfatase demonstrated a two-fold increase in activity in the first sib as compared to the second. Possible mechanisms through which the fragile X mutation can cause down-regulation of adjacent loci are discussed.

EARLY NEUROLOGICAL PREDICTORS OF ONE-YEAR OUTOOME IN BIRTH ASPHYXIATED INFANTS

Perinatal asphyxia remains a leading cause of mortality and morbidity in the term neonate. Although certain clinical features have been associated with poor outcome in infants with asphyxia, it has been difficult to accurately identify in the neonatal period those infants who will have subsequent mental and motor handicap.In this study, 34 consecutive term infants with birth asphyxia who were admitted to a neonatal intensive care unit received a detailed neurological examination during the first week of life. Eighteen also underwent CT scans in the first 72 hours. Based on these respective examinations, the authors developed a neonatal post-asphyxial neurological examination score (PAS) and a CT ratio reflective of the degree of hypodense areas of the brain. At one year of age, the surviving 28 infants received a Bayley examination, a measure of head circumference, and the Amiel-Tison neurological examination on which they were rated as normal, suspect, or abnormal.Results showed that the PAS and CT ratio measures were significantly related to each other (p < .01) and that both of these measures were significantly correlated with mental and motor scores on the Bayley, head circumference, and neurologic rating at one year (rs ranged from .70 to .83; ps from < .05 to < .005). Thus, PAS and CT ratio are new measures which appear to be effective in predicting neurodevelopmental outcome of full-term, birth asphyxiated infants at one year of age.