Gail Ross

Growth and Development of Premature Infants Fed Predominantly Human Milk, Predominantly Premature Infant Formula, or a Combination of Human Milk and Premature Formula

Background In a recent meta-analysis, human milk feeding of low birth-weight (LBW) infants was associated with a 5.2 point improvement in IQ tests. However, in the studies in this meta-analysis, feeding regimens were used (unfortified human milk, term formula) that no longer represent recommended practice. Objective To compare the growth, in-hospital feeding tolerance, morbidity, and development (cognitive, motor, visual, and language) of LBW infants fed different amounts of human milk until term chronologic age (CA) with those of LBW infants fed nutrient-enriched formulas from first enteral feeding. Methods The data in this study were collected in a previous randomized controlled trial assessing the benefit of supplementing nutrient-enriched formulas for LBW infants with arachidonic acid and docosahexaenoic acid. Infants (n = 463, birth weight, 750–1,800 g) were enrolled from nurseries located in Chile, the United Kingdom, and the United States. If human milk was fed before hospital discharge, it was fortified (3,050–3,300 kJ/L, 22–24 kcal/oz). As infants were weaned from human milk, they were fed nutrient-enriched formula with or without arachidonic and docosahexaenoic acids (3,300 kJ/L before term, 3,050 kJ/L thereafter) until 12 months CA. Formula fed infants were given nutrient-enriched formula with or without added arachidonic and docosahexaenoic acids (3,300 kJ/L to term, 3,050 kJ/L thereafter) until 12 months CA. For the purposes of this evaluation, infants were categorized into four mutually exclusive feeding groups: 1) predominantly human milk fed until term CA (PHM-T, n = 43); 2) ≥ 50% energy from human milk before hospital discharge (≥ 50% HM, n = 98); 3) < 50% of energy from human milk before hospital discharge (< 50% HM, n = 203); or 4) predominantly formula fed until term CA (PFF-T, n = 119). Results PFF-T infants weighed approximately 500 g more at term CA than did PHM-T infants. This absolute difference persisted until 6 months CA. PFF-T infants were also longer (1.0–1.5 cm) and had larger head circumferences (0.3–1.1 cm) than both PHM-T and ≥ 50% HM infants at term CA. There was a positive association between duration of human milk feeding and the Bayley Mental Index at 12 months CA (P = 0.032 full and P = 0.073 reduced, statistical models) after controlling for the confounding variables of home environment and maternal intelligence. Infants with chronic lung disease fed ≥ 50% HM until term CA (n = 22) had a mean Bayley Motor Index about 11 points higher at 12 months CA compared with infants PFF-T (n = 24, P = 0.033 full model). Conclusion Our data suggest that, despite a slower early growth rate, human milk fed LBW infants have development at least comparable to that of infants fed nutrient-enriched formula. Exploratory analysis suggests that some subgroups of human milk fed LBW infants may have enhanced development, although this needs to be confirmed in future studies.

HOME INTERVENTION FOR PREMATURE INFANTS OF LOW-INCOME FAMILIES

Low-income families with premature newborns received home intervention regarding the care and development of their infants. Infants in these families were found to have higher mental ability scores, to be judged as having easier temperaments, and to be more likely to live in homes which facilitated development than were matched controls at one year of age.

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.

Neuromotor development of preterm and full-term infants

The Neuromotor Behavioral Inventory (NBI), a 16-category measure of muscle tone, developmental motor abilities, quality of movement, neurological reflexes and reactions, and neuromotor outcome was used with 38 infants divided into three groups: healthy preterm (HPT), sick preterm (SPT), and healthy full-term (HFT) infants. Infants were tested at five time points: 40 weeks postconception (newborn) and 3, 6, 9 and 12 months of age post-term. The intent of the study was two-fold: to determine whether there are developmental differences among the groups of infants and whether the differences persist during the first year of life. Results indicate that HFT and HPT infants score higher than SPT infants in the neuromotor categories of: muscle tone, upper extremity development, head control, and neuromotor outcome rating. HFT infants scored higher than both preterm groups in: trunk rotation, reaction to movement, visual and auditory attention, and fixing. Differences persisted among the groups during the first year of life in the following: the developmental motor ability of trunk rotation, fixing, adaptability, and the neuromotor outcome rating. It appears that neonatal health status is a contributing factor to infant neuromotor development, particularly in the quality of movement reactions.

Effects of Subependymal and Mild Intraventricular Lesions on Visual Attention and Memory in Premature Infants.

This study evaluated 10-month-old infants to determine if supependymal or mild intraventricular hemorrhage (S/IVH) affects visual attention, visual memory, or memory for location. Thirty premature infants with normal ultrasound scans, 30 premature infants with S/IVH, and 30 full-term infants were evaluated on a habituation/novelty preference task, the AB object permanence task, and the Bayley Scales of Infant Development

Growth achievement in low-birth-weight premature infants: Relationship to neurobehavioral outcome at one year

Previously published studies present conflicting conclusions about the growth of small, premature infants. To provide further data on these infants, a well-defined group of 86 premature infants appropriate for gestational age, weighing less than 1501 gm at birth, was observed until 12 months after their expected dates of delivery. Length, weight, and head circumference were measured at one, three, six, nine, and 12 months postterm. At 12 months postterm, infants were evaluated by neurologic examination and the Bayley Scales of Infant Development. Premature infants with mean Bayley scores greater than or equal to 85 were found to be significantly larger than infants with mean Bayley scores less than 85 by three months postterm. Birthweight, gestational age, duration of hospitalization in the neonatal intensive care unit, pneumonia, hypoglycemia, perinatal neurologic impairment, acidosis, and hypoxemia were found to be associated with reduced growth at one year. Conflicting results in previous studies may be a result of failure to separate infants with good neurobehavioral outcome from those with poor outcome.

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.

Neurocognitive impairment in childhood-onset systemic lupus erythematosus: Measurement issues in diagnosis

To assess the prevalence of neurocognitive impairment (NCI) in childhood‐onset systemic lupus erythematosus (cSLE) by comparing published classification criteria, and to examine associations between NCI, disease characteristics, psychosocial well‐being, and intelligence.

Effects of implementing family-centered rounds (FCRs) in a neonatal intensive care unit (NICU).

Objectives: (1) Evaluate impact of FCR on provider satisfaction and collaboration. (2) Evaluate impact of FCR on parent satisfaction with provider communication. Methods: Collaboration and Satisfaction about Care Decisions (CSACD) questionnaire was given to staff on 4 patients 2 days a week for 5 weeks prior to and 6 months after implementation of FCR. Parents received a Parents Stress Scale and Neonatal Instrument of Parent Satisfaction before discharge, prior to and 6 months after starting FCR.Results: 278/288 (97%) staff surveys were completed, 142 pre and 136 post. On the CSACD survey NNPs and fellows showed increased (p < 0.05) collaboration and satisfaction post FCR. No group had decreased satisfaction. Twenty-eight of 45 (62%) parent surveys were completed, 12 pre and 16 post. Parents’ satisfaction scores increased (p < 0.01) pre vs. post on survey items regarding communication, meeting with physicians, and obtaining information about their infants. Conclusions: FCR was associated with enhanced collaboration among team members for NNPs and fellows. Parents’ satisfaction scores increased post FCR on survey items regarding communication. Since NNPs and fellows are the primary communicators with parents, the increased satisfaction may reflect improved communication due to FCR. This added opportunity for open dialogue may also contribute to the increased parent satisfaction.