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van der Pal-de Bruin KM, van der Pal SM, Verloove-Vanhorick SP, Walther FJ. Profiling the preterm or VLBW born adolescent; implications of the Dutch POPS cohort follow-up studies. Early Hum Dev 2015; 91:97-102. [PMID: 25590235 DOI: 10.1016/j.earlhumdev.2014.12.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 09/29/2014] [Accepted: 12/17/2014] [Indexed: 10/24/2022]
Abstract
In 1983, data of a unique nationwide cohort of 1338 very preterm (<32 weeks of gestation) or VLBW (birth weight<1500g) infants in the Netherlands was collected and followed at several ages until they reached the age of 19 years. At 19 years of age a more extensive follow-up study was done, including questionnaires, tests on a computer and a full physical exam. These studies provide insight into how Dutch adolescents at 19 years of age, who were born very preterm or with a very low birth weight (VLBW), reach adulthood. At 19 years, 705 POPS participants participated (74% of 959 still alive). Outcome measures at 19 years included: physical outcomes (e.g. blood pressure), cognition, behavior, quality of life, and impact of handicaps. The POPS participants showed more impairments on most outcome measures at various ages, compared to norm data. Major handicaps remained stable as the children grew older, but minor handicaps and disabilities increased. At 19 years of age, only half (47.1%) of the survivors had no disabilities and no minor or major handicaps. Especially those born small for gestational age (SGA) seem most vulnerable. These long-term results help to support preterm and SGA born children and adolescents in reaching independent adulthood, and stress the need for long term follow-up studies and to promote prevention of disabilities and of preterm birth itself.
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Affiliation(s)
| | | | - S P Verloove-Vanhorick
- TNO Child Health, Leiden, The Netherlands; Leiden University Medical Center, Department of Pediatrics, Leiden, The Netherlands
| | - F J Walther
- Leiden University Medical Center, Department of Pediatrics, Leiden, The Netherlands
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Teune MJ, van Wassenaer AG, van Dommelen P, Mol BWJ, Opmeer BC. Perinatal risk indicators for long-term neurological morbidity among preterm neonates. Am J Obstet Gynecol 2011; 204:396.e1-396.e14. [PMID: 21788170 DOI: 10.1016/j.ajog.2011.02.055] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Revised: 01/24/2011] [Accepted: 02/15/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Many obstetric interventions are performed to improve long-term neonatal outcome. However, long-term neonatal outcome is usually not a primary outcome because it is time-consuming and expensive. The aim of this project was to identify different perinatal risk indicators and to develop prediction models for neurologic morbidity at 2 and 5 years of age. STUDY DESIGN Data from a Dutch cohort study of preterm and small-for-gestational-age infants was used. Neonates who were born in The Netherlands in 1983 with a gestational age of <34 weeks and without congenital abnormalities were included (n = 753). Infants were divided in 3 groups: no handicap, minor handicap, and major handicap. RESULTS Common risk indicators for major handicaps at 2 and 5 years of age were male sex (odds ratio, 2.7 and 3.0, respectively), seizures after ≥2 days of life (odds ratio, 5.8 and 5.8, respectively), and intracranial hemorrhage (odds ratio, 3.8 and 2.6, respectively). CONCLUSION In this cohort, male sex, intracranial hemorrhage, and seizures seem to be important risk indicators for long-term neurologic morbidity.
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Hille ETM, Weisglas-Kuperus N, van Goudoever JB, Jacobusse GW, Ens-Dokkum MH, de Groot L, Wit JM, Geven WB, Kok JH, de Kleine MJK, Kollée LAA, Mulder ALM, van Straaten HLM, de Vries LS, van Weissenbruch MM, Verloove-Vanhorick SP. Functional outcomes and participation in young adulthood for very preterm and very low birth weight infants: the Dutch Project on Preterm and Small for Gestational Age Infants at 19 years of age. Pediatrics 2007; 120:e587-95. [PMID: 17766499 DOI: 10.1542/peds.2006-2407] [Citation(s) in RCA: 120] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Young adults who were born very preterm or with a very low birth weight remain at risk for physical and neurodevelopmental problems and lower academic achievement scores. Data, however, are scarce, hospital based, mostly done in small populations, and need additional confirmation. METHODS Infants who were born at < 32 weeks of gestation and/or with a birth weight of < 1500 g in The Netherlands in 1983 (Project on Preterm and Small for Gestational Age Infants) were reexamined at age 19. Outcomes were adjusted for nonrespondents using multiple imputation and categorized into none, mild, moderate, or severe problems. RESULTS Of 959 surviving young adults, 74% were assessed and/or completed the questionnaires. Moderate or severe problems were present in 4.3% for cognition, 1.8% for hearing, 1.9% for vision, and 8.1% for neuromotor functioning. Using the Health Utility Index and the London Handicap Scale, we found 2.0% and 4.5%, respectively, of the young adults to have > or = 3 affected areas in activities and participation. Special education or lesser level was completed by 24%, and 7.6% neither had a paid job nor followed any education. Overall, 31.7% had > or = 1 moderate or severe problems in the assessed areas. CONCLUSIONS A total of 12.6% of young adults who were born very preterm and/or with a very low birth weight had moderate or severe problems in cognitive or neurosensory functioning. Compared with the general Dutch population, twice as many young adults who were born very preterm and/or with a very low birth weight were poorly educated, and 3 times as many were neither employed nor in school at age 19.
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Affiliation(s)
- Elysée T M Hille
- Division of Neonatology, Department of Pediatrics, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
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MORITAKE K, NAGAI H, MIYAZAKI T, NAGASAKO N, YAMASAKI M, SAKAMOTO H, MIYAJIMA M, TAMAKOSHI A. Analysis of a Nationwide Survey on Treatment and Outcomes of Congenital Hydrocephalus in Japan. Neurol Med Chir (Tokyo) 2007; 47:453-60; discussion 460-1. [DOI: 10.2176/nmc.47.453] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Kouzo MORITAKE
- Department of Neurosurgery, Shimane University School of Medicine
| | - Hidemasa NAGAI
- Department of Neurosurgery, Shimane University School of Medicine
| | - Takeshi MIYAZAKI
- Department of Neurosurgery, Shimane University School of Medicine
| | - Noriko NAGASAKO
- Department of Neurosurgery, Shimane University School of Medicine
| | - Mami YAMASAKI
- Department of Neurosurgery and Clinical Institute, Osaka National Hospital, National Hospital Organization
| | - Hiroaki SAKAMOTO
- Department of Pediatric Neurosurgery, Osaka City General Hospital
| | | | - Akiko TAMAKOSHI
- Medical Department of Preventive Medicine/Biostatistics and Medical Decision Making, Nagoya University Graduate School of Medicine
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5
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Abstract
Marked differences are seen in neurological and health status, intellectual functioning, school performance and behaviour between children born prematurely and those born at term. Assessment in later childhood has identified more subtle problems than the severe disability or sensory deficits readily identifiable at two years. These problems include learning disabilities, specific neuropsychological deficits in executive function, difficulties in visual-motor integration and perception, selective language impairment, motor coordination disorders, behaviour problems, attention deficit hyperactivity disorder (ADHD), and reduced educational achievement. Follow-up to school entry and beyond is thus required to determine the true prevalence and nature of the neurodevelopmental problems arising from preterm birth. Consensus about the assessment used, definitions of disability and health status, age of assessment and who undertakes it are necessary and should allow comparison across populations; this may help to maximise outcomes for children clearly at biological risk. Assessment of outcome for children born preterm beyond two years is required for counselling parents, planning health and education provision, for evaluation of services and to facilitate understanding of the longer term effects of preterm birth on brain development.
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Affiliation(s)
- Alison Salt
- The Wolfson Centre, Consultant Community Paediatrician, Mecklenburgh Square, London WC1N 2AP, United Kingdom.
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van de Bor M, den Ouden L. School performance in adolescents with and without periventricular-intraventricular hemorrhage in the neonatal period. Semin Perinatol 2004; 28:295-303. [PMID: 15565790 DOI: 10.1053/j.semperi.2004.08.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Long-term sequelae of preterm birth have been studied extensively up until the age of 5 to 8 years. However, the cognitive development of adolescents born preterm has received limited attention. The objective of this study is to determine school performance in adolescents born very preterm. We have followed up a cohort of 484 infants born before 32 weeks of gestation in whom cranial ultrasound was routinely and systematically performed. School performance was assessed in the surviving adolescents at 14 years of age. The outcome variable divided the adolescents into three groups: (1) normal, (2) slow learners, and (3) special education. School performance data were obtained from 278 of 304 surviving adolescents; 129 performed normally, while 107 were slow learners, and 42 needed special education. From the unadjusted odds ratios for the need of special education by the various perinatal factors, only the odds ratio for periventricular-intraventricular hemorrhage was significantly associated (2.56, 95% confidence interval 1.17-4.86). Logistic regression analysis revealed that, after correction for possible confounding factors, the odds ratios for special education were significantly higher for adolescents with all grades of periventricular-intraventricular hemorrhage. Less than 50% of adolescents born before 32 weeks gestation perform normally in school. Periventricular-intraventricular hemorrhage, including the lower grades,does have an unfavorable additional effect on school performance.
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Affiliation(s)
- Margot van de Bor
- Department of Pediatrics, University of Nijmegen Medical Center, Nijmegen, The Netherlands.
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Abstract
Experience with certain perinatal interventions, such as supplemental oxygen and dexamethasone, leads to the conclusion that follow-up data are needed to be well informed about the safety of certain perinatal interventions. Experience with indomethacin suggests that follow-up data also are regarded by some clinicians as a necessary aspect of evidence about effectiveness. Ideally, clinical trials of perinatal interventions might involve collection of data about neonatal predictors of outcome (such as a neuroimaging study and a standardized neurologic assessment); several developmental and neurologic assessments before school entry; a comprehensive evaluation of the child's cognitive function, behavioral competencies, and academic performance at 7 to 8 years of age; serial detailed assessments of the family psychosocial functioning; and an inventory of resources available for the child. Many clinical trials have not included follow-up after the neonatal period, and in such cases information about the effect of the intervention on participants' HRQL is incomplete. The approach taken in several recent trials, in which the outcome of interest is neurodevelopmental outcome at 18 months, attempts to strike a balance between a theoretical ideal (a comprehensive, longitudinal follow-up through school age) and a follow-up regimen that is not prohibitively expensive. Such trials include follow-up during the first 1 to 3 years of life, when major disabilities can be identified reliably, thereby providing moderately informative data about participants' eventual quality of life, related to the presence or absence of major disability. If, however, there is reason to suspect that the intervention has effects on the developing brain, follow-up after school entry may provide additional evidence pertinent to the risks and benefits of the intervention.
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Affiliation(s)
- T Michael O'Shea
- Department of Pediatrics, Wake Forest University Health Sciences, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
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Jessen EC, Colver AF, Mackie PC, Jarvis SN. Development and validation of a tool to measure the impact of childhood disabilities on the lives of children and their families. Child Care Health Dev 2003; 29:21-34. [PMID: 12534564 DOI: 10.1046/j.1365-2214.2003.00312.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Information on registers of children with special needs will be more meaningful if a validated measure of the severity of impact of a child's disability on life and family is included. DESIGN We describe the development and initial validation of a parent-completed questionnaire (Generic Lifestyle Assessment Questionnaire LAQ-G) aimed at measuring such impact. RESULTS Data were collected on 95 case children, representing various disabilities, and 65 control children without disability, and analysed for case-control, test-re-test and inter-reporter reliability. Multidimensional scaling techniques were then used to derive six domains, representing impact of disability in a structure analogous to the participation domains of the revised International Classification ICF (WHO 2001). CONCLUSIONS Initial results suggest that the LAQ-G is a reliable measure of the impact of disability for children with a range of common disabling conditions.
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Affiliation(s)
- E C Jessen
- Northumberland Care Trust, Child Health Office, The Bondgate Surgery, Alnwick, Northumberland, UK.
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9
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Lorenz JM, Paneth N, Jetton JR, den Ouden L, Tyson JE. Comparison of management strategies for extreme prematurity in New Jersey and the Netherlands: outcomes and resource expenditure. Pediatrics 2001; 108:1269-74. [PMID: 11731647 DOI: 10.1542/peds.108.6.1269] [Citation(s) in RCA: 88] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To quantify differences in resource expenditure in the perinatal period and long-term outcome of extremely premature infants who received systematically different approaches to neonatal intensive care. METHODS Perinatal management, mortality, prevalence of disabling cerebral palsy (DCP), and resource expenditure of 2 population-based inception cohorts of extremely premature infants born in the mid-1980s were compared. Electronic fetal monitoring, tocolysis, cesarean section delivery, and assisted ventilation were used to characterize management approaches. Participants included all live births at 23 to 26 weeks' gestation in a 3-county area of central New Jersey (NJ) from 1984 to 1987 (N = 146) and throughout the Netherlands (NETH) in 1983 (N = 142). Mortality and the prevalence of DCP were the primary outcomes. Numbers of hospital days with and without assisted ventilation were the measures of resource expenditure. RESULTS Electronic fetal monitoring (100% vs 38%), cesarean section (28% vs 6%), and assisted ventilation (95% vs 64%) were all more commonly used in NJ than in NETH. Ten percent of NJ deaths occurred without assisted ventilation, compared with 45% of Dutch deaths. A total of 1820 ventilator days were expended per 100 live births in NJ, compared with 448 in NETH. The increase in the number of nonventilator days (3174 vs 2265 days per 100 live births) did not reach statistical significance. Survival to age 2 (46 vs 22%) and the prevalence of DCP among survivors (17.2 vs 3.4%) were significantly greater in NJ at age 2 than in NETH at age 5. CONCLUSIONS Near universal initiation of intensive care in NJ, compared with selective initiation of intensive care in NETH, was associated with 24.1 additional survivors per 100 live births, 7.2 additional cases of DCP per 100 live births, and a cost of 1372 additional ventilator days per 100 live births.
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Affiliation(s)
- J M Lorenz
- Department of Pediatrics, Columbia University, New York, New York, USA.
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Engel J, Mahler E, Anteunis L, Marres E, Zielhuis G. Why are NICU infants at risk for chronic otitis media with effusion? Int J Pediatr Otorhinolaryngol 2001; 57:137-44. [PMID: 11165651 DOI: 10.1016/s0165-5876(00)00462-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Newborns in a Neonatal Intensive Care Unit (NICU) and even later have a high incidence of otitis media with effusion (OME). It is unclear which aspects play a role in the incidence of chronic OME during infancy. In order to investigate the effect of nasally-placed tubes, cranial growth, immune system, and neuromotor function on the occurrence of chronic OME, 83 NICU patients were observed prospectively for middle ear status. Duration and type of treatment with nasal tubes were obtained from the NICU notes. At the NICU, and 1 and 2 years of age the cranial circumference and neuromotor function were assessed. As a proxy for disturbed local immune system parental reports of snoring, mouth breathing and common cold were used. Multivariate analysis revealed that infants treated with nasotracheal and nasopharyngeal tubes showed a marginally significant increased risk for chronic OME (OR=3.2 [95% CI 0.5--21.2]). Treatment with nasogastric tubes appeared to have a lower risk for chronic OME (OR=1.5 [95% CI 0.1--25.1]). No significant effect was found for cranial circumference. Signs of disturbed local immunity during the first 6 months of life (OR=1.4 [95% CI 0.4--4.7]), as well as impaired neuromotor function (OR=1.9 [95% CI 0.5--6.8]), showed also a marginally significant increased risk for chronic OME. The cohort of NICU patients might be relatively too small in order to find significant effects. Although the results of this study should be interpreted cautiously, it is suggested that nasally-placed tubes for ventilatory assistance, disturbed local immunity and impaired neuromotor function are associated with chronic OME.
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Affiliation(s)
- J Engel
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Maastricht, Maastricht, The Netherlands.
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11
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Walther FJ, den Ouden AL, Verloove-Vanhorick SP. Looking back in time: outcome of a national cohort of very preterm infants born in The Netherlands in 1983. Early Hum Dev 2000; 59:175-91. [PMID: 10996273 DOI: 10.1016/s0378-3782(00)00094-3] [Citation(s) in RCA: 110] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In 1983, Dutch pediatricians collaborated on a national level and collected perinatal data on 1338 liveborn infants with a gestational age <32 weeks and/or a birthweight <1500 g (project on preterm and small for gestational age infants, POPS). Their outcome was assessed at 2 years of age by their pediatricians, at 5 years by a team of investigators, and at 9-14 years by questionnaires completed by parents, teachers, and children themselves. The overall picture that emerges from this 14-year follow-up is that a low percentage of these very preterm infants (10%) has a severe disability or handicap at school age. Although 90% of the children are without severe disabilities at school age, many of them meet serious difficulties in everyday life and the burden of mild developmental abnormalities, behavioral and learning disorders increases with age. In adolescents, it is likely that as many as 40% of the survivors will not be able to become fully independent adults. Abnormalities found during early, standardized clinical neurological examination are highly predictive for these later problems.
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Affiliation(s)
- F J Walther
- Department of Pediatrics, Leiden University Medical Center, 2300 RC, Leiden, The Netherlands.
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Colver A, Jessen C. Measurement of health status and quality of life in neonatal follow-up studies. SEMINARS IN NEONATOLOGY : SN 2000; 5:149-57. [PMID: 10859709 DOI: 10.1053/siny.1999.0002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Mortality and neuro-developmental outcome can be precisely measured but in order to interpret the significance of changes in them, further information is needed about health status, the effect of health status on lifestyle of survivors and their families, the quality of life experienced by survivors and the value placed by the public and survivors on different health states. The ability to measure such aspects of health now allows more relevant follow-up studies to be designed. This article discusses concepts of health status and quality of life and the problems in applying these to children. There follows a critique of modern instruments for measuring health status and quality of life and their application in neonatal follow-up studies. We recommend that only a small number of well-established instruments should be considered so that results are valid and can be compared with other studies.
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Affiliation(s)
- A Colver
- Northumbria Health Care NHS Trust, University of Newcastle upon Tyne, Department of Community Child Health, UK.
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van Domburg PH, Willemsen MA, Rotteveel JJ, de Jong JG, Thijssen HO, Heerschap A, Cruysberg JR, Wanders RJ, Gabreëls FJ, Steijlen PM. Sjögren-Larsson syndrome: clinical and MRI/MRS findings in FALDH-deficient patients. Neurology 1999; 52:1345-52. [PMID: 10227616 DOI: 10.1212/wnl.52.7.1345] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine the spectrum of clinical and MRI/1H MRS features of patients with fatty aldehyde dehydrogenase (FALDH) deficiency. BACKGROUND The Sjogren-Larsson syndrome (SLS) was originally defined as a clinical triad consisting of ichthyosis, spastic di- or tetralegia, and mental retardation, with autosomal recessive inheritance. By now, both the deficiency of the enzyme FALDH, and the genetic mutations on chromosome 17 responsible for this deficiency, have been identified. SLS, defined by fibroblast FALDH deficiency, seems to be a much broader syndrome. METHODS The clinical findings of 11 FALDH-deficient patients of different ages and one patient with the characteristic SLS-like ichthyosis, but without FALDH deficiency, were evaluated in relation to their cerebral MRI, and to 1H MRS in six patients. RESULTS The severity of neurologic symptoms showed considerable variation. Fundoscopic perifoveal glistening dots and the characteristic SLS-like ichthyosis were present in all patients. Serial MRI findings showed evidence of retarded myelination and a variable degree of dysmyelination. 1H MRS showed an accumulation of free lipids in the periventricular white matter, even before the stage of visible dysmyelination. CONCLUSIONS The neurologic consequences of FALDH deficiency show considerable variation. The characteristic pattern of ichthyosis and retinal degeneration are seen consistently, yet they are not pathognomonic. MRI and 1H MRS findings suggest an accumulation of long-chain fatty alcohol intermediates, resulting in retarded myelination and dysmyelination.
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Affiliation(s)
- P H van Domburg
- Department of Neurology, Laurentius Hospital, Roermond, The Netherlands
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Kornhauser MS, Baumgart S, Desai SA, Stanley CW, Culhane J, Cullen JA, Wiswell TE, Graziani LJ, Spitzer AR. Adverse neurodevelopmental outcome after extracorporeal membrane oxygenation among neonates with bronchopulmonary dysplasia. J Pediatr 1998; 132:307-11. [PMID: 9506646 DOI: 10.1016/s0022-3476(98)70450-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The relationship between bronchopulmonary dysplasia (BPD) and neurodevelopmental outcome after extracorporeal membrane oxygenation (ECMO) has not been extensively reported. We compared the outcomes in a large series of infants with and without BPD after ECMO. STUDY DESIGN Hospital charts and follow-up records of 145 infants treated with ECMO (1985 through 1990) were reviewed. Complete long-term respiratory and follow-up outcome data were available in 64 infants. BPD occurred in 17 survivors; the remaining 47 did not have BPD. RESULTS Babies with BPD were more likely to have had respiratory distress syndrome. Mean (+/- SD) age at ECMO initiation was later for the BPD group (127+/-66 vs 53+/-39 hours, p < 0.001), and the duration of ECMO treatment was longer (192+/-68 vs 119+/-53 hours, p < 0.001). Bayley Scales of Infant Development scores at <30 months were lower in infants with BPD (p < 0.001), as were three of four Mullen Scales of Early Learning scores (> or = 30 months, p < 0.001 or p = 0.01). At 57+/-16 months 11 (64%) patients with BPD had mild neurologic disabilities, and 3 (18%) had severe disabilities. At a similar age (53+/-16 months, p = NS) 16 (34%) patients without BPD had mild disabilities, whereas 2 (4%) had severe disabilities (p < 0.01). CONCLUSIONS The occurrence of BPD after ECMO is associated with adverse neurodevelopmental outcome. Patients with BPD after ECMO merit close long-term follow-up.
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Affiliation(s)
- M S Kornhauser
- Department of Pediatrics, Thomas Jefferson University, Jefferson Medical College, Philadelphia, Pennsylvania, USA
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15
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Janssens HM, de Haan MJ, van Kamp IL, Brand R, Kanhai HH, Veen S. Outcome for children treated with fetal intravascular transfusions because of severe blood group antagonism. J Pediatr 1997; 131:373-80. [PMID: 9329412 DOI: 10.1016/s0022-3476(97)80061-3] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To describe the outcome for 92 fetuses treated between May 1987 and January of 1993 with intrauterine (intravascular) transfusions for severe hemolytic disease in comparison with a high-risk and a healthy control group. STUDY DESIGN Information on the perinatal period was obtained from the patient records. The children regularly attended the outpatient clinic, and a general pediatric examination was performed on each visit. The psychometer development of the child until age 4 1/2 years was assessed according to Gesell. At the age of 5 years, the adaptation part of the Denver Developmental Screening Test and a Dutch-language test were used. A neurologic examination was performed according to Touwen. RESULTS In our study, 77 (83.7%) of 92 fetuses were born alive after intravascular transfusions. The overall survival rate was 79.3%. The follow-up group included 69 infants, with an age range of 6 months to 6 years. Correlation between antenatal and perinatal features showed a significant negative relationship between the number of intrauterine transfusions and the duration of phototherapy (p = 0.002). The probability that neurologic abnormalities would occur was significantly greater when perinatal asphyxia had been present (p < 0.05) and with a lower cord hemoglobin level at birth (p = 0.03). The total number of children with disabilities was 10.1% (7/69). CONCLUSIONS The neurodevelopmental outcome for the group of survivors compared favorably with a group of high-risk, very low birth weight infants (10.1% to 18%), and less favorably with a healthy control group (10.1% to 6%).
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Affiliation(s)
- H M Janssens
- Department of Pediatrics, University Hospital Leiden, The Netherlands
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16
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Affiliation(s)
- M C McCormick
- Department of Maternal and Child Health, Harvard School of Public Health, 677 Huntington Ave., Boston, MA 02115, USA
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17
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Hack M, Klein N, Gerry Taylor H. School-age outcomes of children of extremely low birthweight and gestational age. ACTA ACUST UNITED AC 1996. [DOI: 10.1016/s1084-2756(96)80047-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Den Ouden AL, Kok JH, Verkerk PH, Brand R, Verloove-Vanhorick SP. The relation between neonatal thyroxine levels and neurodevelopmental outcome at age 5 and 9 years in a national cohort of very preterm and/or very low birth weight infants. Pediatr Res 1996; 39:142-5. [PMID: 8825399 DOI: 10.1203/00006450-199601000-00021] [Citation(s) in RCA: 169] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Transient neonatal hypothyroxinemia is very common in preterm infants. The literature on the effect of this hypothyroxinemia is, however, controversial, and large or long-term follow-up studies are not available. In a nationwide prospective follow-up study on very preterm and (or) very low birth weight infants (n = 717), we studied the relationship between thyroxine levels in the 1st wk of life and neurodevelopmental outcome at 5 y of age and school performance at 9 y of age. Thyroxine concentrations from filter paper eluates were determined in 717 infants: 32% had levels of more than 3 SD below the mean (< 60 nmol/L). The percentage of infants with such low levels increased with decreasing gestational age. At the age of 5 y, 96% of survivors (n = 640) were available for extensive neurodevelopmental examination: 85 (13.3%) had a disability and 92 (14.3%) a handicap. At the age of 9 y, 83% of survivors (n = 552) answered a questionnaire on school performance: 300 (54.3%) were in mainstream education in a grade appropriate for age, 151 (27%) were in mainstream education with grade retention, and 101 (18.3%) were in special education. Both neurologic dysfunction at age 5 y and school failure at age 9 y were significantly related to lower neonatal thyroxine levels even after adjustment for other perinatal factors (odds ratio, 1.3). Whether this relationship is causal should be investigated. If a causal relationship exists, substitution therapy may at least partially prevent neurologic dysfunction and learning disabilities, both common sequelae of very preterm birth.
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Mccormick MC, Stewart JE, Cohen R, Joselaw M, Osborne PS, Ware J. Follow-up of NICU Graduates: Why, What, and by Whom. J Intensive Care Med 1995. [DOI: 10.1177/088506669501000503] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Follow-up of the graduates of neonatal intensive care is an important component of the provision of such care. However, the objectives of these programs and their data-collection strategies vary widely. This report describes the potential objectives and different data-collection strategies. It then reviews briefly what is known about the outcomes of very low birth weight infants to guide the development of assessment packets: Finally, we describe the operation of our program and activities of our team to illustrate the follow-up experience in a large multi-institution program.
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Affiliation(s)
- Marie C. Mccormick
- Infant Follow-up Program, Joint Program in Neonatology, Children's Hospital
- Department of Maternal and Child Health, Harvard School of Public Health, Boston, MA
| | - Jane E. Stewart
- Infant Follow-up Program, Joint Program in Neonatology, Children's Hospital
| | - Robyn Cohen
- Infant Follow-up Program, Joint Program in Neonatology, Children's Hospital
| | - Marsha Joselaw
- Infant Follow-up Program, Joint Program in Neonatology, Children's Hospital
| | | | - Janice Ware
- Infant Follow-up Program, Joint Program in Neonatology, Children's Hospital
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20
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Hille ET, den Ouden AL, Bauer L, van den Oudenrijn C, Brand R, Verloove-Vanhorick SP. School performance at nine years of age in very premature and very low birth weight infants: perinatal risk factors and predictors at five years of age. Collaborative Project on Preterm and Small for Gestational Age (POPS) Infants in The Netherlands. J Pediatr 1994; 125:426-34. [PMID: 8071753 DOI: 10.1016/s0022-3476(05)83290-1] [Citation(s) in RCA: 141] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
To assess the impact of both perinatal disorders and developmental problems identified at preschool age on school performance, we followed a virtually complete birth cohort of very premature (< 32 completed weeks of gestation) and very low birth weight infants until they were 9 years of age. In 84% of the survivors (n = 813), data on school performance were available for analysis. At the age of 9 years, 19% of the children were in special education. Of the children in mainstream education, 32% were in a grade below the appropriate level for age and 38% had special assistance. After correction for other perinatal items, children of low socioeconomic status and boys had significantly higher adjusted odds ratios for special education. Logistic regression with a perinatal and a 5-year time category showed that the most predictive factors for special education were developmental delay, neuromotor and speech/language function, inattention and hyperactivity score, total problem score, and reported school results at the age of 5 years. When children with disabilities were left out of the analysis, the importance of neuromotor function and total problem score disappeared. Increased risks of any school failure in nondisabled children included mild or severe developmental delay and marginal or poor school performance at the age of 5 years. Long-term follow-up with specific attention to these predictors at 5 years of age, although time-consuming, is necessary.
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Affiliation(s)
- E T Hille
- TNO Institute of Preventive Health Care, Leiden, The Netherlands
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21
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Saigal S, Rosenbaum P, Stoskopf B, Hoult L, Furlong W, Feeny D, Burrows E, Torrance G. Comprehensive assessment of the health status of extremely low birth weight children at eight years of age: comparison with a reference group. J Pediatr 1994; 125:411-7. [PMID: 8071751 DOI: 10.1016/s0022-3476(05)83288-3] [Citation(s) in RCA: 103] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To apply a multiattribute health status (MAHS) classification system to data available on two cohorts of school-aged children to describe several dimensions of health simultaneously. The MAHS system describes both the type and severity of functional limitations according to seven attributes: sensation, mobility, emotion, cognition, self-care, pain, and fertility (fertility not applicable in this study), with four or five levels of function within each attribute. DESIGN The MAHS system was applied retrospectively to clinical and psychometric data collected prospectively at age 8 years. MAHS application was by selection of items from the database and development of computer-assisted algorithms to assign functional levels within each attribute. SETTING Geographically defined region in central-west Ontario, Canada. PARTICIPANTS One hundred fifty-six extremely low birth weight (ELBW) survivors born between 1977 and 1982 (follow-up rate 90%) and 145 reference children matched for age, sex, and socioeconomic status. RESULTS 14% of ELBW subjects had no functional limitations, 58% had reduced function for one or two attributes, and 28% had at least three affected. The corresponding figures for the reference group were 50%, 48%, and 2% (p < 0.0001). The limitations were more severe and complex in the ELBW group, and were notably in cognition (58%), sensation (48%), mobility (21%), and self-care (17%), compared with 28%, 11%, 1%, and 0% for reference children (all p < 0.0001). CONCLUSIONS These data indicate that fewer ELBW than reference children were free of functional limitations and a significantly higher proportion had multiple attributes affected. The MAHS classification approach is a useful instrument to compare the health status of different groups and populations, and to monitor changes with time.
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Affiliation(s)
- S Saigal
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
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22
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Sassen ML, Veen S, Schreuder AM, Ens-Dokkum MH, Verloove-Vanhorick SP, Brand R, Ruys JH, Grote JJ. Otitis media, respiratory tract infections and hearing loss in pre-term and low birthweight infants. Clin Otolaryngol 1994; 19:179-84. [PMID: 7923835 DOI: 10.1111/j.1365-2273.1994.tb01210.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
In 1983, 1338 liveborn infants with a gestational age of less than 32 weeks and/or a birthweight of less than 1500 g, were enrolled in a national follow-up study in The Netherlands. At the age of 5 years, 966 children were alive. Of these, 927 (96%) were assessed on a home visit 2-6 weeks after their fifth birthday by three specially trained paediatricians. An assessment of ENT morbidity was made and compared with ENT morbidity in full-term children of the same age group. Markedly preterm birth or very low birthweight does not seem to be a risk factor for developing middle ear disease in childhood, however, the rate of ENT problems seems to be higher than in the general population of Dutch pre-school children.
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Affiliation(s)
- M L Sassen
- ENT Department, University Hospital Leiden, The Netherlands
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Ens-Dokkum MH, Johnson A, Schreuder AM, Veen S, Wilkinson AR, Brand R, Ruys JH, Verloove-Vanhorick SP. Comparison of mortality and rates of cerebral palsy in two populations of very low birthweight infants. Arch Dis Child Fetal Neonatal Ed 1994; 70:F96-100. [PMID: 8154921 PMCID: PMC1061008 DOI: 10.1136/fn.70.2.f96] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Comparisons of mortality and rates of cerebral palsy in different populations can be confusing. This is illustrated by comparing two populations of very low birthweight infants born in the 1980s, one from the Netherlands, the other from the UK (Oxford region). Although a number of biases were controlled for while comparing two large geographically defined populations, by assessing the survivors at similar ages and describing their health status in a standard way, some problems in interpretation of outcome remained. Differences in registration practice of live births at early gestational ages, as well as differences in withholding or withdrawing treatment, which occurred in about half of the cases of neonatal death in the Netherlands and in about one third of those in the Oxford region, may have influenced the incidence of registered live births, neonatal mortality, and the rate of cerebral palsy.
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Affiliation(s)
- M H Ens-Dokkum
- Institute for Deaf Children and Adolescents Effatha, Voorburg/Zoetermeer, The Netherlands
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24
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Gravenhorst JB, Schreuder AM, Veen S, Brand R, Verloove-Vanhorick SP, Verweij RA, van Zeben-van der Aa DM, Ens-Dokkum MH. Breech delivery in very preterm and very low birthweight infants in The Netherlands. BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1993; 100:411-5. [PMID: 8518238 DOI: 10.1111/j.1471-0528.1993.tb15263.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To study the relation between various perinatal factors and the sequelae of very preterm birth, applying logistic regression analysis. DESIGN In a nationwide collaborative study in the Netherlands, perinatal and follow up data were collected on 899 liveborn singleton nonmalformed infants with gestational age less than 32 weeks or birthweight less than 1500 g born in 1983. MAIN OUTCOME MEASURES Neonatal mortality rate and total handicap rates (minor and major) in surviving children at two years and five years of age. RESULTS Comparing breech with vertex presentation, the odds ratio for neonatal mortality (adjusted for duration of pregnancy, birthweight, maternal hypertension and prolonged rupture of membranes) is 1.6 (P < 0.05). Comparing abdominal versus vaginal delivery, the odds ratio indicates equal risks. When breech and vertex presentation are analysed separately it appears that breech presenting infants have a significantly lower mortality risk when born by caesarean section compared with vaginal delivery. However, comparing abdominal versus vaginal delivery in breech presentation, the odds ratio for handicap at five years (0.9) is not significantly different from 1. CONCLUSION The data presented suggest a reduced neonatal mortality rate in breech presenting infants born by caesarean section but because of the observational design of the study the statistical analysis described only identifies a possible trend and cannot prove the issue.
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Affiliation(s)
- J B Gravenhorst
- Dept. of Obstetrics & Gynaecology, University Hospital, Leiden, The Netherlands
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25
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Qvigstad E, Verloove-Vanhorick SP, Ens-Dokkum MH, Schreuder AM, Veen S, Brand R, Oostdijk W, Ruys JH. Prediction of height achievement at five years of age in children born very preterm or with very low birth weight: continuation of catch-up growth after two years of age. Acta Paediatr 1993; 82:444-8. [PMID: 8518520 DOI: 10.1111/j.1651-2227.1993.tb12719.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
To predict height at five years in a cohort of 565 very preterm and/or very low-birth-weight children, hypothesized growth determinants were subjected to discriminant analysis. Many neonatal parameters were not significantly associated with short stature at five years of age. A correct classification of stature (smaller/larger than the 10th percentile at five years of age) could be obtained in 85% of children, using the following variables: height at two years of age; total (or mid) parental height; parental level of education; length at one year of age; hypertension during pregnancy; sex; weight at two years of age; length percentile at one year of age. However, when compared to actual longitudinal data, the false-positive rate was 37%. The survey also demonstrated the continuing catch-up growth in very preterm and very low-birth-weight infants after two years of age.
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Affiliation(s)
- E Qvigstad
- Faculty of Medicine, University of Trondheim, Norway
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26
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Veen S, Sassen ML, Schreuder AM, Ens-Dokkum MH, Verloove-Vanhorick SP, Brand R, Grote JJ, Ruys JH. Hearing loss in very preterm and very low birthweight infants at the age of 5 years in a nationwide cohort. Int J Pediatr Otorhinolaryngol 1993; 26:11-28. [PMID: 8444543 DOI: 10.1016/0165-5876(93)90192-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
In a geographically defined population of very preterm and very low birthweight infants (gestational age < 32 weeks and/or birthweight < 1500 g) hearing was evaluated in 890 children by pure-tone audiometry at the age of 5 years. Hearing loss was conductive/unspecified in 123 (13.8%) and sensorineural in 13 (1.5%) children. The prevalence of sensorineural hearing loss was 15 times as high as in 5-7 year old children in the Dutch population at large. The sensorineural hearing loss prevalence in very low birthweight and extremely low birthweight infants was similar. On account of communication disorders 10 (1.1%) children were classified as disabled and 6 (0.7%) as handicapped, following the definitions of the International Classification of Impairments, Disabilities, and Handicaps of the World Health Organisation. Children with conductive hearing loss had a higher risk of impairments, disabilities and handicaps of language and speech development, than children with normal hearing, the difference being statistically significant. The same holds for children with sensorineural hearing loss; moreover they had a significantly higher risk of impairments, disabilities and handicaps of mental development. Overall comparison of children with and without sensorineural hearing loss proved that the children with sensorineural hearing loss had a significantly less favourable outcome, based on 15 perinatal factors simultaneously. The age at which sensorineural hearing loss in very preterm and/or very low birthweight infants is detected has to be improved.
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Affiliation(s)
- S Veen
- Department of Pediatrics, University Hospital Leiden, The Netherlands
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Verloove-Vanhorick SP, Kloosterboer-Boerrigter I, Schreuder AM, Veen S, Ens-Dokkum MH. Cohort reconstruction. Paediatr Perinat Epidemiol 1992; 6:387-9. [PMID: 1635888 DOI: 10.1111/j.1365-3016.1992.tb00779.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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