Mona Sadek-Badawi

School achievement in a regional cohort of children born very low birthweight.

Children born very low birthweight (VLBW, <=1500 g) have historically had lower average school achievement than their normal birthweight peers. However, perinatal care and survival have changed dramatically since prior cohorts accrued, prompting reassessment. Surfactant therapy became generally available 8/1/1990, and the use of ante- and postnatal steroids increased substantially around this time. Standardized test scores and teacher ratings in math, reading, science, and social studies were obtained at age 10 for a cohort of children admitted to six regional NICUs in Wisconsin and Iowa, 8/1/1988 - 6/30/1991. We compared achievement between the VLBW cohort and controls from the same school districts. Among VLBW children, we determined neonatal and early childhood factors associated with achievement on standardized tests (ordinal logistic regression) and teacher ratings (linear regression) and evaluated whether achievement differed by birth year. Compared to population controls, VLBW childrens greatest deficits occurred in mathematics. Scores on the standardized math exam and teacher ratings of overall achievement were positively associated with birthweight, social function measured at age five, and socioeconomic status. VLBW children born in the post-surfactant era (after 8/1/1990) had lower achievement on the standardized math exam than children born during the pre-surfactant era of the prior two years. Lower achievement in the post-surfactant era may be due to greater survival among less healthy neonates or increased exposure to postnatal steroids. VLBW children more likely to struggle academically could be identified by early childhood measures, allowing for targeted interventions to mitigate their difficulties.

The trajectory of IGF-1 across age and duration of type 1 diabetes.

Individuals with type 1 diabetes may have low IGF‐1, related to insulinopenia and insulin resistance. There are few longitudinal studies of IGF‐1 levels to establish its pattern in type 1 diabetes with duration and age, and to examine whether IGF‐1 tracks within individuals over time. We examine age and duration trends, and the relationship of IGF‐1 to gender, glycaemic control, insulin level and other factors.

Predictors of receiving therapy among very low birth weight 2-year olds eligible for Part C early intervention in Wisconsin

BackgroundThe Individuals with Disabilities Education Act (Part C) authorizes states to establish systems to provide early intervention services (e.g., therapy) for children at risk, with the incentive of federal financial support. This study examines family and neighborhood characteristics associated with currently utilizing physical, occupational, or speech therapy among very low birthweight (VLBW) 2-year-old children who meet Wisconsin eligibility requirements for early intervention services (EI) due to developmental delay.MethodsThis cross-sectional analysis used data from the Newborn Lung Project, a regional cohort study of VLBW infants hospitalized in Wisconsin’s newborn intensive care units during 2003–2004. We included the 176 children who were age two at follow-up, and met Wisconsin state eligibility requirements for EI based on developmental delay. Exact logistic regression was used to describe child and neighborhood socio-demographic correlates of parent-reported receipt of therapy.ResultsAmong VLBW children with developmental delay, currently utilizing therapy was higher among children with Medicaid (aOR = 5.3, 95% CI: 1.3, 28.3) and concomitant developmental disability (aOR = 5.2, 95% CI: 2.1, 13.3) and lower for those living in a socially more disadvantaged neighborhood (aOR=0.48, 95% CI: 0.21, 0.98, per tertile).ConclusionsAmong a sample of VLBW 2-year olds with developmental delays who are EI-eligible in WI, 4 out of 5 were currently receiving therapy, per parent report. Participation in Medicaid positively influences therapy utilization. Children with developmental difficulties who live in socially disadvantaged neighborhoods are at highest risk for not receiving therapy.

Daycare attendance and risk for respiratory morbidity among young very low birth weight children

Daycare attendance and very low birth weight (VLBW, ≤1,500 g) are associated with respiratory morbidity during childhood. The objective of this study was to evaluate whether daycare attendance is associated with even higher risk for respiratory problems among VLBW children. We hypothesized that VLBW children attending daycare, in a private home or daycare center, are at higher risk for respiratory problems than VLBW children not attending daycare. We also investigated whether the effect of daycare is independent or synergistic with respiratory risk resulting from being VLBW, as indicated by having bronchopulmonary dysplasia (BPD) as a neonate. We conducted a prospective study of VLBW children followed from birth to age 2–3 (N = 715). Logistic regression was used to evaluate the relationship between daycare attendance and respiratory problems, adjusting for known neonatal risk factors for poor respiratory outcomes. Attending daycare in either a private home or in a daycare center was significantly associated with higher risk of lower respiratory infections than never attending. Attending a daycare center was also associated with higher risk for wheezy chest, cough without a cold, and respiratory medication use. While having BPD was associated with increased risk for respiratory problems, daycare attendance and BPD were not found to be synergistic risk factors for respiratory problems among VLBW children, but acted independently to increase risk. This implies that the increase in risk for respiratory problems associated with daycare attendance may be similar among VLBW children and those of normal birth weight. Pediatr Pulmonol. 2009; 44:1093–1099. ©2009 Wiley‐Liss, Inc.

Relationship Between Neighborhood Disadvantage and Social Function of Wisconsin 2- and 3-Year-Olds Born at Very Low Birth Weight

OBJECTIVE To examine whether (1) neighborhood disadvantage is associated with social function in 2- and 3-year-olds born at very low birth weight (<1500 g) and (2) the association between social function and childs health-related quality of life (HRQoL) is moderated by neighborhood disadvantage. DESIGN Cross-sectional study using the Newborn Lung Project, a cohort of infants born at very low birth weight in 2003 and 2004 in Wisconsin. SETTING Wisconsin. PARTICIPANTS This study includes the subgroup of 626 non-Hispanic black or white infants who were followed up at ages 24 to 43 months with parent-reported health and developmental information. MAIN EXPOSURE An index of neighborhood disadvantage was derived by principal component analysis of 5 census tract variables (percentage of families in poverty, percentage of households with income higher than the state median, percentage of women with bachelors degree or more, percentage of single mothers, and percentage of mothers of young children unemployed). Children were then classified (based on index tertiles) as living in either disadvantaged, middle advantage, or advantaged neighborhoods. Childrens HRQoL was measured using the Pediatric Quality of Life Inventory. MAIN OUTCOME MEASURE Social function was measured using the Pediatric Evaluation of Disability Inventory. RESULTS Adjusting for child medical and family socioeconomic attributes, social function was lower (mean difference, -4.60; 95% confidence interval, -8.4 to -0.8) for children living in disadvantaged vs advantaged neighborhoods. We also found that the ill effects of lower HRQoL are particularly bad for children living in a disadvantaged neighborhood. CONCLUSION Children born at very low birth weight have disparities in social function at ages 2 and 3 years that are associated with both HRQoL and neighborhood characteristics.

Racial disparities in health-related quality of life in a cohort of very-low-birth-weight 2- and 3-year-olds with and without asthma

Background Children born very low birth weight (VLBW) are at risk for low health-related quality of life (HRQoL), compared with normal-birth-weight peers, and racial disparities may compound the difference. Asthma is the most pervasive health problem among VLBW children and is also more common among black than white children, partly due to unfavourable environmental exposures. This study explores racial disparities in HRQoL among VLBW children and examines whether potential disparities can be explained by asthma and neighbourhood disadvantage. Methods The study population was the Newborn Lung Project, a cohort of infants (n=660) born VLBW in 2003–2004 in Wisconsin, USA, who were followed up at age 2–3. Multilevel linear regression models were used to examine the contributions of asthma, neighbourhood disadvantage, and other child and family socio-demographic covariates, to racial disparities in HRQoL at age 2–3. A childs HRQoL was measured using the Paediatric Quality of Life Inventory 4.0. Results VLBW, black, non-Hispanic children, on average, score nearly 4 points lower (p<0.01) on HRQoL than do white, non-Hispanic children. Including asthma reduces the difference between black and white children from −3.6 (p<0.01) to 0.08 (p>0.05). The authors found no evidence that the relationship between asthma and HRQoL differs by race. The interaction between neighbourhood disadvantage and asthma is statistically significant, with further examination suggesting that racial disparities are particularly pronounced in the most advantaged neighbourhoods. Conclusion The authors found that the black disadvantage in HRQoL among 2–3-year-old VLBW children likely stems from a high prevalence of asthma. Neighbourhood attributes did not further explain the disparity, as the racial difference was particularly pronounced in advantaged neighbourhoods.

Association of BPD and IVH with early neutrophil and white counts in VLBW neonates with gestational age <32 weeks

Objective:To investigate associations between early low neutrophil count from routine blood samples, white blood count (WBC), pregnancy complications and neonatal outcomes for very low birth weight infants (VLBW ⩽1500 g) with gestational age <32 weeks.Study Design:Information was abstracted on all infants admitted to level III neonatal intensive care units in Wisconsin 2003 to 2004. A total of 1002 VLBW neonates (78%) had differential and corrected total white counts within 2 ½ h of birth. Data analyses included frequency tables, binary logistic, ordinal logistic and ordinary regression.Result:Low neutrophil count (<1000 per μl) was strongly associated with low WBC, pregnancy complications and antenatal steroids. Low neutrophil count predicted bronchopulmonary dysplasia severity level (odds ratio, OR: 1.7, 95% confidence interval, CI: 1.1 to 2.7) and intraventricular hemorrhage grade (OR: 2.2, 95% CI: 1.3 to 3.8).Conclusion:Early neutrophil counts may have multiple causes interfering with their routine use as an inflammatory marker. Nonetheless, low neutrophil count has consistent independent associations with outcomes.

Racial disparities in health-related quality of life in a cohort of very low birthweight 2- and 3-year-olds with and without cerebral palsy.

We examine racial differences in health‐related quality of life (HRQoL) among 2‐ and 3‐year‐olds born very low birthweight (VLBW, <1500g). The sample included 611 children (290 males and 321 females) from the Newborn Lung Project, a cohort of VLBW infants hospitalized in Wisconsin’s newborn intensive care units during 2003 to 2004. Of the 611 children, 14% (86/611) were black, non‐Hispanic and 86% (525/611) were white, non‐Hispanic and 4% (23/611) had cerebral palsy. HRQoL was measured using the Pediatric Quality of Life Inventory. Black children scored nearly four points lower (mean difference −3.6, 95% confidence interval [CI]: −6.9 to −0.3) on HRQoL than their white peers. Cerebral palsy is associated with lower HRQoL (mean difference −24.4, 95% CI: −29.3 to −19.5), especially among black children, but does not explain racial differences in HRQoL. Living in a neighborhood with lowest levels of female education is associated with lower HRQoL (mean difference −5.6, 95% CI: −9.2 to −2.1), but does not explain the racial difference in HRQoL.