Predicting developmental outcome at school age from infant tests of normal, at-risk and retarded infants

Neurodevelopmental outcome in very low birthweight infants with necrotizing enterocolitis requiring surgery

OBJECTIVE

To assess the effect of necrotizing enterocolitis (NEC) on neurodevelopmental outcome.

METHODOLOGY

Neurodevelopmental outcome of 20 very low birthweight (VLBW) infants who developed NEC requiring surgery was compared with 40 matched infants controlled for gestation, birthweight, and year of admission. Twenty-nine VLBW infants who developed NEC and did not require surgery were also compared.

RESULTS

Infants with NEC needing surgery were of 26 +/- 2 weeks gestation and weighted 892 +/- 192 g at birth. Infants with NEC managed medically were of higher gestation (27 +/- 2 weeks) but similar birthweights. More infants with NEC requiring surgery required inotropic support. At follow up, NEC surgery infants had a significantly higher incidence of developmental morbidity. 11 of 20 compared with 11 of 40 matched controls (Fisher's exact test P = 0.0493), and six of 29 infants with NEC managed medically (Fisher's exact test P = 0.0174).

CONCLUSIONS

These findings stress the importance for close follow up for neurodevelopmental sequelae in VLBW infants who have had NEC requiring surgery.

Early child health in Lahore, Pakistan: XII. Milestones

Psychomotor development was assessed in 1476 infants from four different levels of urbanization in and around Lahore, Pakistan. Development was assessed monthly at birth to 24 months of age by using a set of 10 milestones selected from the Denver Developmental Screening Test and the Developmental Screening Inventory. The psychomotor development of children in the upper middle (Um) class was consistent with reference population groups in Europe and North America, hence this group was used as control. There was significant delay in the psychomotor development of infants belonging to the poorer areas compared to the Um class. There was no sex difference in the development of the milestones in any study area, except for girls in the Um class who were earlier for about one month than boys in talking. Infants in the poorer areas were, on average about 3 months, delayed in their walking and fine motor activity (building a tower of 3 cubes) in comparison with the Um class. Observed disturbance in psychomotor development at an early age may affect the abilities and achievements in later life.

The role of social support and stressors for mothers and infants

This correlational study of mothers and their 6-month-old infants examined the importance of social support and stressors for parenting and infant development. Mothers (n = 79) were primarily White, married, and ranged in socio-economic status from low to high. All data were collected in mothers' homes when infants were 6 months old. Diversity of sources of social support and diversity of father support were positively related to parenting (quality of stimulation in the home). Diversity of sources of social support buffered the negative relationship of maternal fatigue (stressor) to parenting. Parenting was related to social, hearing-speech, locomotor, and general development. Additionally, social support and aggravation (people in the mother's said network who make life difficult) were related to infant development, independent of parenting.

Current developments in the understanding of mental retardation. Part I: Biological and phenomenological perspectives

During the past decade, noteworthy advances have taken place within the field of mental retardation. The application of advanced biological techniques in such areas as molecular genetics and neuroimaging has substantially improved our ability to identify the biological factors that underlie the origin and pathogenesis of an increasing number of mental retardation syndromes. Refined genetic and psychosocial assessments have highlighted the impressive degree of heterogeneity that is present within and across many mental retardation syndromes, stimulating increasing interest and study. This, the first of a two-part review, will focus on recent developments in biological and phenomenological aspects of mental retardation.

Early fine motor and adaptive development in high-risk appropriate for gestational age preterm and healthy term children

The development of fine motor and adaptive skills during the first 2 years of life is reported in 97 high-risk preterm children and 94 healthy term children. Most stages of fine motor and adaptive development were found to occur at slightly later ages among preterm children. Neurological development was significantly correlated with fine motor and adaptive development in preterm children only. No significant influence of prenatal, perinatal and postnatal variables on fine motor and adaptive development was noted. No significant sex differences were observed in both the term and preterm group. The strongest predictors of later intellectual functioning were fine motor performance at 9 months and fine motor and adaptive skills at 18 to 24 months.

Children of battered women: developmental and learning profiles

Children in battered women's shelters have been shown to have more behavior problems than their peers but limited information is available about their development. A pilot survey was undertaken to determine the prevalence of developmental or academic problems in children of residents of a battered women's shelter. Demographic data, medical and school histories and responses to standardized developmental or behavioral surveys were obtained from 39 mothers of 76 children. Two-thirds of the children were victims of abuse. On the Minnesota Child Development Inventory, the mean General Developmental Quotient (DQ) of 28 preschool children was 98; however, 39% had developmental delays by test criteria. Of 46 school-aged children, 21 (46%) had evidence of academic problems, including grade repetition, failing grades and need for special educational services. On the Louisville Behavior Checklist, 75% of 48 children had behavior problems. Children in a battered women's shelter are likely to experience academic and behavioral problems; however, further study is needed to elucidate etiological factors.

Neurological outcome in high risk weight appropriate for gestational age preterm children at early school age

Neurological development in preterm children with birth weight appropriate for gestational age is reported in two separate groups: a longitudinal study of 97 preterm children and 93 term children as a control group and a cross-sectional study of 249 preterm children. Both preterm groups were regarded as high risk with respect to number of outborns, distribution of gestational age and perinatal risk factors. Neurological outcome at 5-6 years of age in the majority of the preterm children was comparable to that of the term children. However, 15% of boys and 9% of girls in the preterm group were diagnosed as having cerebral palsy. Mild diplegia was most frequently observed; 4% of the children were severely impaired. Fourteen percent of the preterm vs 2% of the term boys and 6-9% of the preterm vs none of the term girls received motor therapy during early school age. There was a small but consistent sex difference in neurological outcome in favour of the term and preterm girls. Effects of drop out rate and of incompleteness of ascertainment are reported in detail.

Intellectual outcome, speech and school performance in high risk preterm children with birth weight appropriate for gestational age

Intellectual development, speech and school performance of preterm infants with birth weight appropriate for gestational age are reported in two separate investigations: a longitudinal study of 97 preterm children and 93 term children as a control group, and a cross-sectional study of 249 preterm children. Both preterm groups were regarded as high risk groups with respect to number of outborns, distribution of gestational age and perinatal risk factors. Intellectual outcome at 5 and 7 years of age in the majority of the preterm children was comparable to that of the term children. However, 8% of the preterm boys and 2% of the preterm girls achieved lower IQ scores than any of the term children. Between 15% and 17% of the preterm boys and 9%-12% of the preterm girls did not attend school at grade level, compared to 4% and 2% in the term group, respectively. Intellectual and neurological development and school performance were higher interrelated in the preterm than in the term children. Articulation defects, stuttering and dysgrammatism occurred more frequently in the preterm than in the term children and in boys more so than in girls.