Katrine Tyborg Leversen

Prediction of Neurodevelopmental and Sensory Outcome at 5 Years in Norwegian Children Born Extremely Preterm

OBJECTIVE: To examine the prevalence of neurodevelopmental disability and the predictive value of pre-, peri-, and postnatal data on neurologic, sensory, cognitive, and motor function in children born extremely preterm. METHODS: This was a prospective observational study of all infants born in Norway between 1999 and 2000 with gestational ages between 22 and 27 weeks or birth weights between 500 and 999 g. Cognitive function was assessed with the Wechsler Preschool and Primary Scale of Intelligence–Revised, motor function with the Movement Assessment Battery for Children, and severity of cerebral palsy with the Gross Motor Function Classification for Cerebral Palsy. Disabilities were described as mild, moderate, or severe. RESULTS: Of 371 eligible children, 306 (82%) were examined at a mean (SD) age of 5 years and 10 (4) months. For gestational age less than 28 weeks (n = 239), 26 (11%) children had cerebral palsy alone (n = 21) or in combination with blindness (n = 3) or deafness (n = 2); 1 was blind and 1 was deaf. Of the remaining children, the mean full-scale IQ was 94 ± 15, and significant predictors were (values given as the difference in IQ points [95% confidence intervals]) high maternal education (9.6 [5.7–13.4]), preeclampsia (−7.7 [−12.7 to −2.7]), and retinopathy of prematurity higher than grade 2 (−17.5 [−27.1 to −8.0]). Movement Assessment Battery for Children scores were positively associated with gestational age and prenatal steroids and negatively associated with being small for gestational age, male gender, and having retinopathy of prematurity. Moderate to severe neurodevelopmental disability was more common for gestational ages 25 weeks or less (28 of 87 children) than for 26 to 27 weeks (12 of 152 children; P < .001) and 28 weeks or more (7 of 67 children; P = .001). CONCLUSIONS: The outcome was poorer for children with gestational ages of 25 weeks or less compared with those with gestational ages between 26 and 27 weeks. For those without cerebral palsy, blindness, or deafness, however, gestational age had a limited association with cognitive and motor function.

Neonatal mortality and morbidity in extremely preterm small for gestational age infants: a population based study

Aim: To assess if growth restricted (small for gestational age, SGA) extremely preterm infants have excess neonatal mortality and morbidity. Methods: This was a cohort study of all infants born alive at 22–27 weeks’ post menstrual age in Norway during 1999–2000. Outcomes were compared between those who were SGA, defined as a birth weight less than the fifth percentile for post menstrual age, and those who had weights at or above the fifth percentile. Results: Of 365 infants with a post menstrual age of <28 weeks, 31 (8%) were SGA. Among infants with a post menstrual age of <28 weeks, only chronic lung disease was associated with SGA status (OR 2.7, 95% CI 1.0 to 7.2). SGA infants with a post menstrual age of 26–27 weeks had excess neonatal mortality (OR 3.8, 95% CI 1.3 to 11), chronic lung disease and a significantly higher mean number of days (age) before tolerating full enteral nutrition. SGA infants with a post menstrual age of 22–25 weeks had an excess risk of necrotising enterocolitis. Conclusion: Extremely preterm SGA infants had excess neonatal mortality and morbidity in terms of necrotising enterocolitis and chronic lung disease.

Predicting neurosensory disabilities at two years of age in a national cohort of extremely premature infants.

BACKGROUND Extreme prematurity carries a high risk of neurosensory disability. AIMS Examine which information obtained pre-, peri- and postnatally may be predictive of neurosensory disabilities at 2 years of age. STUDY DESIGN Prospective observational study of all infants born in Norway in 1999 and 2000 with gestational age (GA) 22-27 completed weeks or birth weight (BW) of 500-999 g. OUTCOME MEASURES Incidence of neurosensory disabilities. RESULTS Of 373 surviving children, 30 (8%) had major neurosensory disabilities (26 CP, 6 blind, 3 deaf), and a further 46 (12%) had minor visual or hearing disabilities. The rate of major neurosensory disabilities was 19 of 99 (19%) for children with GA 23-25 vs. 8 of 189 (4%) for GA 26-27 weeks (p<0.001). In a multivariable model, only morbidities detected in the neonatal intensive care unit (NICU) were associated with major neurosensory disabilities; adjusted odds ratios (95% confidence intervals) were 68.6 (18.7, 252.2) for major abnormalities on cerebral ultrasound, 6.8 (1.7, 27.4) for retinopathy of prematurity (ROP) grade>2, 3.2 (1.0, 9.7) for ROP grade 1-2, 6.5 (1.9, 22.3) for prolonged use (> or = 21 days) of steroid treatment for lung disease and 3.1 (1.0, 9.4) for clinical chorioamnionitis. The visual outcome was strongly related to the degree of ROP (p<0.001), and all who had a normal hearing screen in the NICU had normal hearing at 2 years. CONCLUSION NICU morbidities, rather than GA or intrauterine growth are the significant predictors of major neurosensory disabilities among extreme prematurity surviving to discharge from the NICU.

Prediction of outcome at 5 years from assessments at 2 years among extremely preterm children: a Norwegian national cohort study.

Aim:  To examine the predictive value of early assessments on developmental outcome at 5 years in children born extremely preterm.

Insulin-induced hypoglycemia stimulates gastric vagal activity and motor function without increasing cardiac vagal activity.

Background/Aims: We investigated whether increasing the efferent vagal activity by insulin-induced hypoglycemia would enhance gastric emptying and volumes in healthy subjects. Methods: Twenty healthy volunteers (10 males) were examined with and without vagal stimulation by insulin-induced hypoglycemia using a glucose clamp technique. Stomach function was tested by drinking meat soup (0.04 kcal ml–1) at a rate of 100 ml min–1 until maximal capacity. Intragastric volume at maximal drinking capacity was determined by three-dimensional ultrasound. Respiratory sinus arrhythmia (RSA) was used as an index of cardiac vagal activity and plasma pancreatic polypeptide (PP) as a measure of gastric vagal activity, and skin conductance (SC) as a measure of sympathetic tone. Results: Insulin-induced hypoglycaemia increased drinking capacity (p = 0.002), gastric emptying (p = 0.02), PP (p = 0.004) and SC (p = 0.004), while intragastric volume was unchanged (p = 0.7) and RSA decreased (p = 0.03). Conclusion: Enhancement of gastric vagal activity by insulin-induced hypoglycemia increased drinking capacity and gastric emptying similarly, resulting in an unchanged intragastric volume. Enhanced efferent vagal activity to the stomach (as measured by PP) was not associated by enhanced cardiac vagal activity (as measured by RSA), possibly a consequence of stress-induced sympathetic activation during the procedure.

Respiratory illness contributed significantly to morbidity in children born extremely premature or with extremely low birthweights in 1999-2000.

This study investigated respiratory morbidity and risk factors during the first five years of life after extremely preterm birth.

O-12 - Mental health among children born extremely premature: a national population based study

Objective To compare mental health at 5 years in children born extremely preterm and at term and assess associations between functional abilities and mental health within the preterm group. Design In a national Norwegian cohort with gestational age (GA) 22–27 weeks or birthweight 500–999g mental health was assessed with The Strengths and Difficulties Questionnaire (SDQ), cognitive function with WPPSI-R, motor function with ABC movement test and severity of cerebral palsy (CP) with the Gross Motor Function Classification for CP (GMFCS). Neurodevelopmental disabilities (NDD) were described as mild and moderate/severe. SDQ of the preterm children was compared with that of a non-selected reference group born at term. SDQ sub-scores ≥90 th percentile were defined as a mental health problem and a total difficulty score ≥90 th percentile (TDS90) as suggestive of psychiatric disorder. Results Of 361 eligible preterm children parents completed SDQ for 255 (71 %). 28 (11 %) had TDS90 compared to 10 of 758 (1 %) of the reference group (OR: 8.4, 95% CI 4.0 to 17.0). For the preterms the rate of TDS90 was higher for those with moderate/severe NDD (12/37 vs. 6/116, OR: 9. 3.0;26.0), but not for those with mild NDD (10/102 vs. 6/116) compared with those with no NDD. For preterms with no NDD TDS90 was more common than for the term reference group (6/116 vs. 10/758, OR:3.7, 1.3;10.0), and the most distinguishing features were emotional and peer problems. Conclusion Extreme prematurity is associated with increased risk of later mental health problems, particularly if they have other functional impairments.

1251 Neurodevelopmental Disabilities and Mental Health in Extreme Preterm Children. A National Population Based Study

Objective To compare mental health at 5 years in children born extremely preterm with a reference group, and assess associations between neurodevelopmental disabilities and mental health within the preterm group. Design In a national Norwegian cohort with gestational age (GA) 22–27 weeks or birthweight 500–999g mental health was assessed with The Strengths and Difficulties Questionnaire (SDQ), cognitive function with the Wechsler Preschool and Primary Scale of Intelligence-Revised (WPPSI-R), motor function with the Movement Assessment Battery for children (ABC-test) and severity of cerebral palsy (CP) with the Gross Motor Function Classification for CP (GMFCS). Neurodevelopmental disabilities (NDD) were described as mild and moderate/severe. SDQ of the preterm children was compared with that of an unselected reference group. SDQ sub-scores ≥90th percentile of the reference group were defined as a mental health problem and a Total Difficulties Score ≥90th percentile (TDS90) as suggestive of psychiatric disorder. Results Of 372 eligible preterm children parents completed SDQ for 255 (69 %). 97(38%) had TDS90 compared to 116 (11%) of the reference group (OR: 5.1; 95% CI 3.7 to 7.1). For the preterms the rate of TDS90 was higher for those with moderate/severe NDD (27/37 vs. 27/116, adjusted OR: 8.09; 95% CI 3.2–19, and mild NDD 43/102 (adjusted OR: 2.2 (1.2–4.1). For preterms with no NDD TDS90 was more common than for the reference group (27/116 vs. 116/1089, OR: 2.5; 95% CI 1.6 to 4.1). Conclusion Extreme prematurity was associated with increased risk of later mental health problems, particularly if they had other neurodevelopmental disabilities.