Maria Franca Coletti

Do Healthy Preterm Children Need Neuropsychological Follow-Up? Preschool Outcomes Compared with Term Peers.

Aim  The aim of this study was to determine neuropsychological performance (possibly predictive of academic difficulties) and its relationship with cognitive development and maternal education in healthy preterm children of preschool age and age‐matched comparison children born at term.

Cognitive assessment of very preterm infants at 2-year corrected age: Performance of the Italian version of the PARCA-R parent questionnaire

BACKGROUND Serial assessments of cognitive and language development are recommended for very preterm children, but standardized neuropsychological testing is time-consuming and expensive, as well as tiring for the child. AIMS To validate the Italian version of the PARCA-R parent questionnaire and test its clinical effectiveness in assessing cognitive development of very preterm children at 2 years of corrected age. METHODS 120 consecutive Italian very preterm children (mean gestational age 28.8 weeks, standard deviation 2.1) were assessed in four hospitals through the Mental Development Index (MDI) of the Bayley Scales of Infant Development (BSID-II). Parents completed the PARCA-R questionnaire, designed to measure childrens non-verbal and verbal (vocabulary and sentence complexity) cognitive level. The correlation between the MDI and the PARCA-R Parent Report Composite (PRC) was tested through the Pearson correlation coefficient, and the receiver operating characteristic (ROC) curve was used to identify optimal PRC cut-offs. RESULTS Significant correlation between the PRC score and MDI (r=0.60, p<0.001) indicated good concurrent validity. The area under the ROC curve was 0.83, and the cut-off of 46 lead to 72.7% sensitivity and 77.1% specificity in identifying children with moderate/severe cognitive delay (MDI<70). Negative predictive value was 96.6 (90.3-99.3). Screening through PARCA-R would reduce the number of children with MDI≥70 undergoing BSID-II or equivalent standardized tool from 109 to 25. CONCLUSIONS The Italian version of PARCA-R retains good discriminative power for identifying cognitive delay in 2-year very preterm children. It is well accepted by parents, and represents a valid and efficient alternative for developmental screening and outcome measurement.

MBL2 gene polymorphisms increase the risk of adverse neurological outcome in preterm infants: a preliminary prospective study

Background:As described in animal models, the lectin-complement pathway is central to the propagation of ischemia–reperfusion injuries in many tissues, including the brain. Similarly, it might affect the genesis of brain damage in preterm infants. MBL2 gene single-nucleotide polymorphisms (SNPs), regulating mannose-binding lectin (MBL) serum levels, could predict the risk of adverse neurological outcome in these infants.Methods:To evaluate the association between SNPs of the MBL2 gene and long-term neurological outcomes in preterm infants, 75 infants (gestational age (GA) ≤ 32 wk) were observed in a prospective longitudinal study and assessed by clinical and instrumental exams at 12 and 24 mo of corrected age (CA). They were genotyped for the promoter polymorphism -221 and for the exon-1 variant alleles (at codons 52, 54, and 57) of the MBL2 gene.Results:The MBL2 exon-1 OO genotype was more frequent in children with an adverse neurological outcome (5/35; 7%) than in controls (0/40; 0%), P = 0.045. The risk of intraventricular hemorrhage in carriers of the genotype OO was marked, without reaching statistical significance (odds ratio: 8.67; 95% confidence interval: 0.87–86.06; P = 0.07).Conclusion:Preterm infants who are carriers of MBL2 exon-1 OO genotype are exposed to an increased risk of adverse neurological outcomes.

Developmental evaluation at age 4: Validity of an Italian parental questionnaire

Aim:  To validate an Italian parental questionnaire designed to evaluate the neuropsychological and behavioural developmental status of 4‐year‐olds and identify children in need of further evaluation.

Neurodevelopmental outcome of Italian preterm children at 1 year of corrected age by Bayley-III scales: An assessment using local norms

BACKGROUND Premature birth is often associated with neurodevelopmental difficulties throughout childhood. In the first three years of life, the Bayley Scales of Infant and Toddler Development-Third Edition (Bayley-III) constitute one of the most used tools for assessing child development. Since Bayley-III original norms are based on United States (US) population, it remains uncertain whether their use in other countries (e.g., European) is appropriate. AIMS This research aimed to examine neurodevelopment of preterm infants and full-term infants, using Bayley-III US norms in comparison to Italian (IT) norms. Patterns of developmental outcomes for both infant groups were also explored. METHODS 104 preterm and 58 full-term infants were included in the study. Bayley-III was used for neurodevelopmental assessment at 1year of corrected age, considering both IT and US norms for scores computation. RESULTS Comparing scores obtained with IT vs US norms, differences in means were all significant across five subscales (p<0.05 at least) for preterm infants, whereas for full-term peers significant differences were found only for Receptive Language and Fine Motor subscales (p<0.001). Effect size (η2) ranged from 0.22 to 0.94. Within each group, significant discrepancies across subscales were found. Moreover, Italian preterm infants had significantly lower performances than full-term peers, excepting for Expressive Language and Gross Motor subscales. CONCLUSIONS As regards to Italian 1-year children, our study seems to provide evidence for the tendency of Bayley-III US norms to overestimate development compared to IT norms. These findings emphasize the need to early detect children at risk for developmental delay and to plan early intervention.

Predictive validity of the Italian parental questionnaire for developmental evaluation at age 4 (QS4-G).

To examine whether the results at 4 years of age of the developmental questionnaire QS4‐G can predict the outcome of cognitive, neuropsychological and academic abilities 4–6 years later. The QS4‐G is a validated parental questionnaire designed for the screening and surveillance of the neuropsychological and behavioural developmental status of 4‐year‐olds (93 questions).

58 Parental Education and Cognitive Profiles at 4 Years of Age in Healthy Very Preterm Children.

BACKGROUND: Improved survival rates for preterm and very low birthweight infants have increased attention towards their long-time neuro-developmental outcome, and particularly cognitive performances. To discriminate the effects of preterm birth from those of its neurological and sensorial consequences, we studied the cognitive function of a sample of healthy preterm children (no IVH stage 3–4; PLV; ROP grade 3–4) at pre-school age.METHODS: Thirty-five healthy preterm children (gestational age less than 33 weeks) were assessed at mean age of 4.4 years (SD 0.3) together with 50 controls born at term and matched for age and gender. Cases were selected from patients attending follow up at a large tertiary Pediatric Hospital. Griffiths scales were used to measure cognitive development. Multivariate regression analysis was adopted to simultaneously explore the effects of preterm birth and socio-demographic factors on cognitive score: parent age and education.RESULTS: Ninty-six % of global developmental Griffiths scores of both cases and controls were within 83–116, corresponding to the scale range of low to high average. However, global mean scores were lower for cases (97) than controls (103) and the difference was statistically significant (p<0.05). In particular, scores of preterm infants were significantly lower in four subscales: locomotor, hand and eye co-ordination, performance, practical reasoning. After adjusting for socio-demographic variables in multivariate analysis, the difference in global scores remained statistically significant (p<0.01). Maternal education was also significant predictor of cognitive development (p<0.05) with higher educational level corresponding to better children performances.CONCLUSIONS: These findings suggest that healthy preterm children at pre-school age, despite a global developmental score in the normal range, still show a lower developmental profile than their term peers, and maternal education also exerts a significant effect. Lower subscale scores point to specific areas of difficulty. These findings have implication for subsequent school performance and therapeutic interventions.