Gitta Reuner

Cognitive development in very vs. moderately to late preterm and full-term children: Can effortful control account for group differences in toddlerhood?

BACKGROUND Preterm birth is thought to have an adverse impact on cognitive development and self-regulation. AIM Examining the effect of very vs. moderately to late premature birth on cognitive development and effortful control, as well as evaluating whether effortful control explains the link between preterm birth and poorer cognitive development. SUBJECTS Fifty-eight very preterm children (<32 weeks gestation or <1500 g birth weight), 88 moderately to late preterm children (≥32 weeks gestation and ≥1500 birth weight) and 86 full-term children (≥38 weeks gestation and ≥2500 g birth weight) were examined at the corrected age of 24 months. OUTCOME MEASURES Observational and parent-report measures of effortful control as well as the Bayley Scales of Infant Development II (BSID II, Mental Scale) as a measurement of cognitive development were analyzed. RESULTS Very preterm and moderately to late preterm children showed significantly lower cognitive performance compared to full-term children. Lower effortful control scores (on observational measures, but not on parent-reports) were merely found for very preterm children compared to full-term children. Observational measures of effortful control partially mediated the effects of very preterm birth on cognitive performance, but did not explain the effects of moderately to late preterm birth on cognitive performance. CONCLUSION Preterm birth in general is related to poorer cognitive performance in toddlerhood. In addition, effortful control mediates the effects of very preterm birth on cognitive development. Findings suggest that different mechanisms link moderately to late premature birth to poor cognitive development.

Intelligence quotient improves after antiepileptic drug withdrawal following pediatric epilepsy surgery.

Antiepileptic drugs (AEDs) have cognitive side effects that, particularly in children, may affect intellectual functioning. With the TimeToStop (TTS) study, we showed that timing of AED withdrawal does not majorly influence long‐term seizure outcomes. We now aimed to evaluate the effect of AED withdrawal on postoperative intelligence quotient (IQ), and change in IQ (delta IQ) following pediatric epilepsy surgery.

Negative reactivity in toddlers born prematurely: Indirect and moderated pathways considering self-regulation, neonatal distress and parenting stress

High negative reactivity in early childhood interferes with later academic and behavioral adjustment. Thus, investigating the origins of high negative affectivity in early childhood is of high relevance for understanding emotional morbidity after preterm birth. The present work explored (1) direct prematurity-related consequences for negative reactivity, (2) self-regulatory deficits as a mechanism indirectly relating prematurity to negative affectivity and (3) the implications of the interplay between procedural distress in the neonatal period and parenting stress for preterm childrens negative reactivity. The sample was comprised of 146 preterm children (very vs. moderately to late preterm) and 86 healthy full-term children, both free of major neurological impairment. Assessment involved negative affect and parenting stress (parent-report; 12, 24 months corrected age, CA), effortful control (behavioral battery, parent report; 24 months CA) and the number of potentially distressing neonatal intensive care procedures as well as severity of illness during the neonatal period (retrospective chart review). There was no direct link from prematurity to a disposition for high negative reactivity in early childhood nor was prematurity indirectly associated with higher negative reactivity through lower levels of effortful control. The relation between neonatal pain and distress and negative affectivity depended on the level of parenting stress with low parenting stress at the end of the first year of childrens life buffering the negative influence of neonatal distress. The present findings underscore the importance of complex interactions among environmental factors in processes of emotional plasticity after preterm birth thereby providing critical suggestions for follow-up care.

Cognitive development in 7- to 24-month-old extremely/very-to-moderately/late preterm and full-term born infants: The mediating role of focused attention

The present study analyzed the links between prematurity, attention, and global cognitive performance in infancy and early childhood. At 7 months, focused attention (FA) was examined with an object examination task in 93 preterm infants (39 of them born extremely/very preterm, 54 born moderately/late preterm, and 38 infants born full-term). Global cognition was assessed at 7 and 24 months with the Bayley-II cognitive scale. Groups did not differ with respect to global cognitive performance but FA of infants born extremely/very preterm was significantly lower than in infants born moderately/late preterm. FA correlated significantly with both prematurity and cognitive performance at 7 months of age but not with global cognition in childhood. Findings point to a subtle adverse effect of prematurity on early attention and reveal evidence for the mediating role of FA on the effect of prematurity on cognition.

Attention and executive functions in the early course of pediatric epilepsy

OBJECTIVE Our prospective study aimed at exploring attention and executive functions in children with new-onset epilepsy prior to and during the early course of antiepileptic treatment. Sociodemographic and epilepsy-related factors were analyzed as potential predictors both of impaired cognitive functions as well as for changes in cognitive functioning in the early course of illness. METHODS From a total group of 115 children aged six to 17years without major disabilities, 76 children were assessed longitudinally with a screening tool for attention and executive functions (EpiTrack Junior®). Sociodemographic variables (gender, age at epilepsy onset, need of special education) and epilepsy-related variables (etiology of epilepsy, semiology of seizures, number of seizures) were considered as potential predictors for impaired functions prior to treatment and for deterioration/amelioration in cognitive functions in the early course. RESULTS Attention and executive functions of children with new-onset epilepsy were significantly more often impaired when compared with a healthy population, but less often when compared with children with chronic epilepsy. The majority of children showed stable cognitive functioning in the early course of treatment. The risk of impaired cognitive functions was significantly heightened when etiology of epilepsy was unknown or not classifiable. The chance for improvement of functioning was lowered by having a genetic epilepsy, or an unknown semiology of seizures. CONCLUSIONS Children with new-onset epilepsy are at high risk for impaired attention and executive functions even prior to antiepileptic treatment, especially when etiology of their epilepsy remains unclear. The high stability of cognitive functioning in the early course can be used in counseling of families who worry about negative side effects of drug treatment. Finally, a systematic assessment of cognitive functions in children with new-onset epilepsy is necessary to detect subtle deficits in the early course and adjust treatment accordingly.

Frontal Lobe Epilepsy Surgery in Childhood and Adolescence: Predictors of Long-Term Seizure Freedom, Overall Cognitive and Adaptive Functioning

BACKGROUND Although frontal lobe resections account for one-third of intralobar resections in pediatric epilepsy surgery, there is a dearth of information regarding long-term seizure freedom, overall cognitive and adaptive functioning. OBJECTIVE To identify outcome predictors and define the appropriate timing for surgery. METHODS We retrospectively analyzed the data of 75 consecutive patients aged 10.0 ± 4.9 yr at surgery that had an 8.1 yr mean follow-up. RESULTS Etiology comprised focal cortical dysplasia (FCD) in 71% and benign tumors in 16% cases. All patients but one had a magnetic resonance imaging-visible lesion. At last follow-up, 63% patients remained seizure-free and 37% had discontinued antiepileptic drugs. Presurgical predictors of seizure freedom were a shorter epilepsy duration, strictly regional epileptic discharges in electroencephalography (EEG), and an epileptogenic zone and/or lesion distant from eloquent cortex. Postsurgical predictors were the completeness of resection and the lack of early postoperative seizures or epileptic discharges in EEG. Higher presurgical overall cognitive and adaptive functioning was related to later epilepsy onset and to a sublobar epileptogenic zone and/or lesion. Following surgery, scores remained stable in the majority of patients. Postsurgical gains were determined by higher presurgical performance and tumors vs FCD. CONCLUSION Our findings highlight the favorable long-term outcomes following frontal lobe epilepsy surgery in childhood and adolescence and underline the importance of early surgical intervention in selected candidates. Early postsurgical relapses and epileptic discharges in EEG constitute key markers of treatment failure and should prompt timely reevaluation. Postsurgical overall cognitive and adaptive functioning is stable in most patients, whereas those with benign tumors have higher chances of improvement.

Associations between neonatal distress and effortful control in preterm born toddlers: does parenting stress act as a moderator?

Abstract Objectives: Self-regulation is a key factor in cognitive and behavioural development. The present work explored the link between neonatal distress and effortful control skills of preterm born toddlers as well as parenting stress as a moderator of this association. Methods: The sample comprised 119 preterm born children without major neurological complications (periventricular leucomalacie, Grade 3 or 4 intraventricular hemorrhage, seizures) or sensory impairment. Assessment involved effortful control (multitask behavioural battery, parent report; 24 months corrected age [CA]), parenting stress (parent-report; 12, 24 months CA), and the number of potentially distressful neonatal intensive care procedures as well as severity of illness during the neonatal period (retrospective chart review). Results: Exposure to a higher number of distressful procedures was related to lower effortful control (behavioural measures only) at the CA of 24 months when adjusting for gestational age, severity of illness and socioeconomic status. In contrast to hypotheses, lower parenting stress did not buffer distress-related effects on effortful control, but independently facilitated the emergence of higher effortful control skills. Conclusion: Findings highlight the role of early adversity for the emergence of self-regulatory difficulties and suggest multiple opportunities for interventions yielding on the promotion of self-regulation in preterm born children.

Visual attention performance in term born and preterm infants with different perinatal risk

Study aim: Preterms are undoubtly at high risk for cognitive developmental delay and impairment. Early assessment is crucial but lacks of reliable and valid procedures. Attention, processing speed and recognition memory are relevant aspects of cognitive development in infancy, thus respective paradigms are of high importance for early diagnosis. The present study investigates the practicability and informative value of a visual habituation-dishabituation-task with categorial stimuli (Pahnke & Pauen, 2006). Methods: Visual speed of processing and memory was assessed in 30 preterms with birth weight 1500g and 30 term borns. In the visual categorization task infants were familiarized with 10 similar looking abstract geometric stimuli and were then tested with another stimulus of contrasting shape and color. As dependent variables different measures of looking duration, strength of habituation and strength of dishabituation were examined. Global development was assessed with a developmental test (Bayley-II), sex and school graduation of parents were controlled for. Results: Data collection has been completed. Preliminary analyses show significant longer total looking times during habituation for preterms with very low birth weight compared to term born infants (Z=–2.00, p<0.05). Data of preterms with higher birth weight are currently coded. Looking times of these infants seem to differ from those of term borns as well. Correlation analyses of looking duration with developmental test scores are in progress. Discussion: Results suggest that total looking time – indicating speed of processing – might play a key role for explaining differences in cognitive performance of preterm and term born infants. Longer looking times seem to be linked with worse cognitive performance in preterms. Future analyses are necessary in order to prove reliability of this assessment procedure and enhance clinical use.