Peter A.M. Auld

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.

Delayed closure of the ductus arteriosus.

Seven infants are described who experienced respiratory difficulty soon after birth, recovered, and subsequently developed typical findings of a patent ductus arteriosus. Five of the infants were in severe protracted congestive heart failure. All recovered with medical management of the cardiac failure and have no residual evidence of cardiac disease.

Measurement of functional residual capacity in distressed neonates by helium rebreathing

A simple bedside helium rebreathing test for measurement of functional residual capacity (FRC) in premature infants is described and evaluated. Twenty-one infants with respiratory distress were studied serially by the method, and a comparable group of nondistressed infants were used as control subjects. Infants with roentgenographic criteria of hyaline membrane disease had significantly decreased FRC. Several other clinical entities were detected: 2 infants with rapid return of FRC to normal associated with streaks on the chest roentgenogram, and one infant with meconium aspiration who had an increased FRC. It is suggested that this method can be used as a diagnostic test as well as an indication of severity of hyaline membrane disease in premature infants.

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.

EARLY PREDICTORS OF NEURODEVELOPMENTAL OUTCOME OF VERY LOW‐BIRTHWEIGHT INFANTS AT THREE YEARS

Seventy‐nine premature infants weighing < 150 lg at birth but appropriate for gestational age underwent a H neurodevelopmental examination at one, three, six, nine and 12 months post‐term, and a standard neurological examination and the Stanford‐Binet Intelligence Scale at three to four years of age. Children were classified as normal, suspect or abnormal on the three‐year neurological examination, on the IQ test, and on composite neurodevelopmental outcome at age three years. Results showed that items from both the nine‐ and 12‐month neurodevelopmental examinations correctly classified about 80 per cent of the children as to composite outcome at three years. In addition, the 12‐month examination enabled correct prediction for 89 per cent of the children as to neurological outcome and for 82 per cent as to IQ.

DEVELOPMENT AND VALIDATION OF A MULTIVARIATE PREDICTOR OF MORTALITY IN VERY LOW BIRTH WEIGHT

Accurate prognosis is critical to the design of all prospective research aimed at improving survival. Predictions based on birth weight, gestational age, or any other single variable, fail to take into account the potentially important contribution of other factors. In order to develop a practical and accurate multivariate model, we studied all singleton pregnancies resulting in viable liveborn infants who weighed less than or equal to 1500 g at birth during 1984 and 1985 at the New York Hospital-Cornell Medical Center. When gestational age, birth weight, and/or crown-heel length were considered, no maternal characteristics were significant predictors of mortality. The model with the maximal predictive accuracy (84.5%) used birth weight and 5-minute Apgar score to calculate a probability of mortality. This prognostic model was then validated in a separate cohort of singletons born in 1986. We conclude that clinical trials should require stratification before randomization, using the calculated probability of mortality, rather than birth weight or gestational age alone. Given the ability of models, such as the one presented here, to generate reasonable estimates of mortality, this information might also be used in the clinical setting to assist parents and physicians in individualized decision-making processes for a given infant.

Cognitive Abilities and Early Precursors of Learning Disabilities in Very-low-birthweight Children with Normal Intelligence and Normal Neurological Status

Fifty-nine of 88 children with birthweights ≤1500 grams had normal Full Scale IQ scores (≥80) and were judged to have normal neurological status at 7 to 8 years old. Twenty-two (37%) of these children were classified as being learning-disabled, as they had academic achievement scores ≤25th percentile. The children with learning disabilities had significantly lower Full Scale and Verbal IQ scores on the Wechsler Intelligence Scale for Children-Revised (1974), but they did not differ significantly from the normal children without learning disabilities on Performance IQ. Learning-disabled children also scored significantly lower on some tests of auditory processing and auditory memory, but not on visuo-motor abilities. Discriminant function analysis indicated that it was possible to correctly predict classification of 81% of the children as learning-disabled or not, based on measures of neonatal respiratory distress and social class level, 1-year mental and neuromotor abilities, and 3-year-old measures of language and visuo-motor integration. Results suggest that verbal deficits, rather than visuo-motor ones, underly learning disabilities at school age in prematurely born children and that these children exhibit signs of subtle neurological impairment at earlier ages.

Oxygen therapy for premature infants

I N C R E A S E D oxygen tensions are not encountered in nature. Therefore, it is not surprising that living tissue develops pathologic changes when exposed to high oxygen concentrations. Because of this danger there is a continuing need to devise adequate criteria for the administration of oxygen to newborn infants. Pediatricians are well aware of the difficulties in safely administering oxygen to newborn infants. After World War I I attempts were made to minimize hypoxic injury in premature infants by nursing them in a high ambient oxygen environment; this led to an increased incidence of retrolental fibroplasia. In reaction to this tragedy there followed an era when therapeutic oxygen concentrations were limited to 40 per cent, even in the presence of cyanosis. Some studies have suggested that this policy resulted in an increased mortali ty rate f rom respiratory distress 1 and an increased morbidity rate f rom cerebral palsy? Now, once again, with the development of the concept of neonatal intensive care: higher concentrations of oxygen are being recommended for dyspneic and cyanotic premature infants. With this perhaps more rational approach, new problems are being encountered in the

Pulmonary function in dysmature infants

Summary Lung function studies in a group of dysmature infants revealed an elevated pH and reduced P co 2 elevated compliance, elevated crying vital capacity, and normal functional residual capacity and arterial-alveolar gradients when compared with premature infants of similar birth weights. These findings are consistent with the observed rarity of hyaline membrane disease in small-for-dates infants, and support the hypothesis that intrauterine stress leads to increased pulmonary maturity.

Physiologic studies on infants with Wilson-Mikity syndrome: Ventilation-perfusion abnormalities and cardiac catheterization angiography†

Abnormalities of ventilation and perfusion were found in infants with the Wilson-Mikity syndrome. Intrapulmonary shunting and maldistribution of ventilation and perfusion were noted. Three patients were subjected to cardiac catheterization and pulmonary hypertension was detected. The increased pulmonary vascular resistance was unresponsive to oxygen, suggesting permanent damage to the pulmonary capillary bed. Angiocardiography showed changes typical of pulmonary hypertension.