Yvonne Rogers

A parent-completed developmental questionnaire: follow up of ex-premature infants

Objective: Premature infants are at increased risk of developmental disability. Early identification of problems allows intervention to ameliorate or attenuate problems. A reliable screening tool allows triage of children in this high‐risk population by identifying those unlikely to need full developmental assessment. To explore the test characteristics of an established parent‐completed developmental assessment questionnaire ‘Ages and Stages Questionnaire’ (ASQ) in follow up of an Australian population of premature infants.

Long term outcome of twin-twin transfusion syndrome

AIMS To compare the perinatal mortality and morbidity of infants with twin-twin transfusion syndrome (TTTS) with those of gestation matched twin controls and to assess the neurodevelopmental outcome of surviving twins with TTTS. METHODS A cohort of 17 consecutive pregnancies with TTTS was enrolled over three years together with gestation matched twin pregnancies unaffected by TTTS. Serial amnioreduction for the TTTS pregnancies was performed as appropriate. Perinatal death and neonatal morbidities were recorded for both the TTTS cohort and controls. The TTTS survivors had neurodevelopmental follow up to at least 2 years of age. RESULTS In 12 of the pregnancies, serial amniocenteses were performed, but, in five, the infants were born before intervention. The mean gestational age at delivery was 29.1 weeks (range 23–36). There were five intrauterine deaths in the TTTS cohort and six neonatal deaths (survival 68%). In the control group, there was one intrauterine death and five neonatal deaths (survival 82%). Infants in the TTTS group had a greater requirement for inotropes (p = 0.04) and a higher incidence of renal failure (p = 0.005). Periventricular leucomalacia and cerebral atrophy were seen in 17% of the TTTS group, but none of the controls (p = 0.03). The 23 surviving TTTS infants were all followed up, with 22% having significant neurological morbidity: cerebral palsy and global developmental delay. CONCLUSIONS Twins with TTTS have high perinatal mortality and neonatal morbidity, and long term neurodevelopmental morbidity in survivors is high. Further investigation into the pathogenesis and management of TTTS is required.

SCHOOL PERFORMANCE OF ELBW CHILDREN: A CONTROLLED STUDY

This paper examines the prevalence of learning difficulty in reading, spelling, mathematics and writing and the prevalence of attention deficit disorder (ADD) in extremely low‐birthweight (ELBW) children at school compared to their peers. Parents of 87 eligible ELBW children completed an educational questionnaire and questionnaire for ADD. Teachers of the ELBW children completed a detailed educational and ADD questionnaire for the study child and two control children in the same class, matched for âge and nearest in birth date to the study child.

Gender differences in cognitive abilities at 2 years in ELBW infants

Gender differences in cognitive abilities exist for children born at term. For very preterm infants uncertainty exists regarding the presence and extent of such differences and their relationship to perinatal brain injury and neurological impairment. This study examined gender differences in cognitive abilities in a cohort of 336 extremely low birth weight (ELBW) infants at 2 years corrected age. Infants were classified as at low or high perinatal risk at birth according to four perinatal risk factors. A subgroup of 33 neurologically impaired infants was identified. Outcome at 2 years was measured by the overall General Quotient (GQ) on the Griffiths scale and its five subscale scores. Female ELBW children were superior to male ELBW children by 4.1 GQ points (95% CI 1.0, 7.1). If the impaired subgroup was excluded, the difference in GQ was 3.2 points (95% CI 0.4, 5.6), and this difference was predominantly due to female infants being superior in the hearing and speech subscale (6.0 points, 95% CI 2.6, 9.5). These differences were relatively independent of perinatal risk status. Gender differences in the Griffiths GQ for ELBW infants are similar to expected differences for term infants and are unlikely to cause substantial bias in interpreting outcome studies for ELBW infants, unless these involve tests of specific cognitive abilities such as language.

Head circumference in ELBW babies is associated with learning difficulties and cognition but not ADHD in the school‐aged child

This study examines whether a small head circumference (HC) and low head‐circumference growth velocity (HGV) during the first year of life predict consequences at school age in learning, cognition, and concentration. A total of 124 extremely‐low‐birthweight (ELBW) infants (birthweight 500 to 999 g) born between 1977 and 1986 were eligible for follow‐up at the corrected ages of 4, 8, and 12 months and 2, 4, and 6 years. Infants were categorized as having a small HC (<3% or 3 to 10%) on the basis of the 1990 British growth data which allowed standardized z ‐scores to be calculated for HC, independent of gestation and corrected age. HGV measurements were calculated using differences in the HC z ‐scores. In 1995, parents of 87 children agreed to participate in a study of learning and attention at school age. Attention‐deficit–hyperactivity disorder (ADHD) was assessed using the Du Paul Rating Scale. Academic performances were based on a teacher questionnaire dealing with aspects of reading, writing, mathematics, and spelling. A child was considered to have a learning difficulty if academic problems were present in at least one of these four areas. Intellectual ability was assessed using the McCarthy Scale at 6 years. HC <3% and 3 to 10% at 8 months’corrected age was strongly associated with school‐aged learning problems (P=0.004), with a moderate specificity (70%), positive predictive value (PPV) (67%), and sensitivity (67%). HGV ?10% from birth to 4 months was also associated with learning problems at school age (P=0.01) with a higher specificity (98%) and PPV (88%) but lower sensitivity (20%). A logistic regression analysis was performed with the risk for

Extremely low birth weight and control infants at 2 years corrected age: A comparison of intellectual abilities, motor performance, growth and health

A 2-year cohort of 63 surviving extremely low birth weight (ELBW) infants was prospectively studied and 60 of these infants, together with 44 normal birth weight control infants, were assessed at 2 years of age for intellectual abilities, motor skills, growth and health. The total ELBW group differed significantly from controls on overall Griffiths developmental quotient (99.3 vs. 103.8 P = 0.02) and in the personal/social subscale (100.7 vs. 106.7 P = 0.01). A subset of 43 of the ELBW infants was identified as low risk at discharge. No statistically significant differences were present between the low risk ELBW subset and controls in intellectual abilities though both the total ELBW group and the low risk ELBW subset differed from controls in fine and gross motor abilities, and in weight at 2 years. The total ELBW group also experienced more frequent ill health and hospital readmission.

Changing patterns of survival and outcome at 4 years of children who weighed 500–999 g at birth

To evaluate the impact of changing perinatal practices on survival rates and 4 year neurodevelopmental outcome for infants of birthweight 500–999 g.

Neonatal cranial ultrasonography as predictor of 2 year outcome of very low birthweight infants

Abstract Real time ultrasound scans using an ATL 300C sector scanner with 5–7.5 MHz transducer were performed on days 1, 4, 7 and thereafter as clinically necessary on 153 consecutively discharged very low birthweight (VLBW) infants. One hundred and forty‐six long‐term survivors were assessed fully at 2 years. The prevalence of cerebroventricular haemorrhage (CVH) in these survivors was 34.2% (grade 1—21.2%; grade 2—4.8%; grade 3—3.4%; grade 4—4.8%), ventricular dilatation 19.9% (including 4.1% with ventriculoperitoneal shunt), and ischaemia 9%. Impairments at 2 years were classified as nil, mild, moderate, severe or multiply severe, based on the criteria of Kitchen et al.

Mortality and neurodevelopmental outcome for infants receiving adrenaline in neonatal resuscitation

To document the outcome, in terms of mortality and morbidity, for all infants requiring adrenaline as part of initial neonatal resuscitation, and to identify the differences between term and preterm infants.

Prevalence and aetiology of neurological impairment in extremely low birthweight infants

Objective: To determine the prevalence and perinatal predictors of cerebral palsy, intellectual impairment, visual impairment and deafness in a cohort of extremely low birthweight (ELBW) infants at two years of age.