Impact of family structure and stability on academic outcome in preterm children at 10 years of age. 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 Neurobehavioral outcomes of school-age children born extremely low birth weight or very preterm in the 1990s. Functional impairments at school age of preterm born children with late-onset sepsis. Neurologic Outcomes at School Age in Very Preterm Infants Born With Severe or Mild Growth Restriction Effect of neonatal surfactant therapy on lung function at school age in children born very preterm. High Prevalence/Low Severity Language Delay in Preschool Children Born Very Preterm Pulmonary function in children with initial low birth weight. Early school-based learning difficulties in children born very preterm.
OBJECTIVE To compare school performance at age 10 years in a cohort of extremely preterm children and term control subjects and to examine the impact of family composition and stability on performance . STUDY DESIGN Prospect i ve , longitudinal follow-up from birth to 10 years of age of a regional cohort of children born at 24 to 31 weeks of gestational age and sociodemographically matched term control subjects .  Family composition , extent of parental care giving , and family moves were tracked sequentially . At 10 years , academic achievement and school performance were ascertained for 118 of 125 ( 94 % ) preterm survivors and 119 of 125 ( 95 % ) term children . RESULTS Term children were more likely to demonstrate optimal school outcome ( appropriate grade level without additional classroom assistance ) than were preterm children ( odds ratio 3.4 , 95 % CI 1.9 - 6.0 ) . Medical complications related to prematurity had little impact on school outcome . Among preterm children , optimal school outcome was significantly associated with increased parental education , child rearing by 2 parents ( regardless of marital status ) , and stability in family composition and geographic residence over 10 years . These environmental influences were less pronounced among term control subjects . CONCLUSION Although preterm children performed less well in school than term children , family factors were stronger predictors of school performance than were perinatal complications 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 prospect i ve 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 h and icap . At the age of 9 y , 83 % of survivors ( n = 552 ) answered a question naire 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 CONTEXT The outcome into school age of regional cohorts of children born in the 1990s with birth weights less than 1000 g ( extremely low birth weight , ELBW ) or earlier than 28 weeks ' gestation ( very preterm ) is not known . OBJECTIVE To determine the cognitive , educational , and behavioral outcome of ELBW or very preterm infants born in the 1990s compared with normal birth weight ( NBW ) controls . DESIGN Regional cohort study . SETTING Victoria , Australia . PARTICIPANTS The ELBW or very preterm cohort was composed of 298 consecutive survivors born during 1991 - 1992 . The NBW cohort was composed of 262 r and omly selected children with birth weights of more than 2499 g. MAIN OUTCOME MEASURES Cognitive ability , educational progress , and behavioral problems . RESULTS The follow-up rates from birth to 8 years of age for survivors were 92.3 % ( 275/298 ) for the ELBW or very preterm cohort and 85.1 % ( 223/262 ) for the NBW cohort . The ELBW or very preterm children scored significantly below NBW controls on full-scale IQ ( mean difference , -9.4 ; 95 % confidence interval [ CI ] , -12.1 to -6.7 ; P<.001 ) and indices of verbal comprehension ( mean difference , -6.8 ; 95 % CI , -9.5 to -4.2 ; P<.001 ) , perceptual organization ( mean difference , -9.9 ; 95 % CI , -12.7 to -7.2 ; P<.001 ) , freedom from distractibility ( mean difference , -8.1 ; 95 % CI , -10.8 to -5.5 ; P<.001 ) , and processing speed ( mean difference , -6.7 ; 95 % CI , -9.4 to -4.0 ; P<.001 ) . The ELBW or very preterm children performed significantly worse than the NBW cohort on tests of reading ( mean difference , -6.7 ; 95 % CI , -9.5 to -3.9 ; P<.001 ) , spelling ( mean difference , -5.6 ; 95 % CI , -8.0 to -3.3 ; P<.001 ) , and arithmetic ( mean difference , -8.8 ; 95 % CI , -11.3 to -6.2 ; P<.001 ) . Attentional difficulties , internalizing behavior problems , and immature adaptive skills were more prevalent in the ELBW or very preterm cohort . CONCLUSION School-aged ELBW or very preterm children born in the 1990s continue to display cognitive , educational , and behavioral impairments BACKGROUND Late-onset sepsis is a relatively common complication particularly of preterm birth that affects approximately a quarter of very low birth weight infants . AIM We aim ed to determine the motor , cognitive , and behavioural outcome at school age of preterm children with late-onset sepsis compared to matched controls . STUDY DESIGN AND SUBJECTS A prospect i ve case-control study that included preterm infants ( gestational age<32weeks and /or birth weight<1500 g ) admitted to our Neonatal Intensive Care Unit in 2000 - 2001 with a culture-proven late-onset sepsis , and controls matched for gestational age . OUTCOME MEASURES At school age we assessed motor skills , intelligence , visual perception , visuomotor integration , verbal memory , attention , executive functioning , and behaviour . RESULTS At 6 - 9years , 21 of 32 children with late-onset sepsis ( 68 % ) had borderline or abnormal motor outcome with most problems in fine motor skills . Their total IQ was 89 compared to 98 in controls . In addition , verbal memory and attention were affected compared to controls ( 0.61 st and ard deviations ( SD ) , 95 % confidence interval ( CI ) 0.04 - 1.17 , p=0.033 and 0.94 SD , 95 % CI 0.32 - 1.62 , p=0.011 , respectively ) . Multiple episodes of sepsis and gram-negative sepsis were risk factors for worse cognitive outcome . CONCLUSIONS At school age , a majority of preterm children with late-onset sepsis had motor problems . Their IQ was considerably lower than matched controls , and memory and attention were specifically impaired . Outcome at school age of preterm children with late-onset sepsis was worse than previously thought OBJECTIVE : To determine whether mild and severe growth restriction at birth among preterm infants is associated with neonatal mortality and cerebral palsy and cognitive performance at 5 years of age and school performance at 8 years of age . METHODS : All 2846 live births between 24 and 32 weeks ' gestation from 9 regions in France in 1997 were included in a prospect i ve observational study ( the EPIPAGE [ Étude Epidémiologique sur les Petits Ages Gestationnels ] study ) and followed until 8 years of age . Infants were classified as “ small-for-gestational-age ” ( SGA ) if their birth weight for gestational age was at the < 10th centile , “ mildly-small-for-gestational-age ” ( M-SGA ) if birth weight was at the ≥10th centile and < 20th centile , and “ appropriate-for-gestational-age ” ( AGA ) if birth weight was at the ≥20th centile . RESULTS : Among the children born between 24 and 28 weeks ' gestation  , the mortality rate increased from 30 % in the AGA group to 42 % in the M-SGA group and to 62 % in the SGA group ( P < .01 ) . Birth weight was not significantly associated with any cognitive , behavioral , or motor outcomes at the age of 5 or any school performance outcomes at 8 years . For the children born between 29 and 32 weeks ' gestation , SGA children had a higher risk for mortality ( adjusted odds ratio [ aOR ] : 2.79 [ 95 % confidence interval ( CI ) : 1.50–5.20 ] ) , minor cognitive difficulties ( aOR : 1.73 [ 95 % CI : 1.12–2.69 ] ) , inattention-hyperactivity symptoms ( aOR : 1.78 [ 95 % CI : 1.10–2.89 ] ) , and school difficulties ( aOR : 1.74 [ 1.07–2.82 ] ) compared with AGA children . Being born M-SGA was associated with an increased risk for minor cognitive difficulties ( aOR : 1.87 [ 95 % CI : 1.24–2.82 ] ) and behavioral difficulties ( aOR : 1.66 [ 95 % CI : 1.04–2.62 ] ) . CONCLUSIONS : In preterm children , growth restriction was associated with mortality , cognitive and behavioral outcomes , as well as school difficulties Our aim was to evaluate long-term effects of exogenous surfactant therapy on pulmonary functional outcome in children born very preterm . We examined 40 children aged 7 - 12 years who were born before 30 weeks of gestation with an immature surfactant system , and were r and omized to one of three treatment groups : human surfactant given at birth ( prophylactic ) , human surfactant given after development of neonatal respiratory distress syndrome ( rescue ) , and placebo ( air ) treatment .  Spirometric parameters of preterm born children were compared with those of 20 children born at term . In addition , spirometric parameters were monitored twice daily for 4 weeks using a home spirometer . All spirometric parameters were significantly lower in the preterm groups than in the controls , except for the forced vital capacity ( FVC ) in the prophylactically treated group . Bronchial obstruction was found in 53 % of the prophylactically treated group , in 36 % of the rescue group , in 67 % of the placebo group , and in 0 % of the control group . Peak expiratory flow ( PEF ) and FVC values were higher in those children who received surfactant compared with the placebo group ( P < 0.05 ) . In 16 children ( 40 % ) born preterm , a beta2-agonist induced an increase in PEF > or = 15 % at least three times during 2 weeks of home monitoring ; eight children ( 20 % ) had abnormal diurnal PEF variation . Multiple regression analysis indicated that the independent variables associated with favorable outcomes in spirometric parameters were  surfactant therapy ( P = 0.012 - 0.045 ) and short intubation time after birth ( P = 0.0009 - 0.0044 ) . Bronchial obstruction , responsiveness to a beta2-agonist , and high diurnal PEF variation are common in children born before 30 gestational weeks . Surfactant supplementation reducing the need for mechanical ventilation or supplementary oxygen after birth may decrease the severity of immaturity related bronchial obstruction in childhood Objective : To examine the language development at corrected age 4 years of a regionally representative cohort of children born very preterm ( VPT ) . Of particular interest was the identification of biological and socioenvironmental risk and protective factors that influence  VPT children 's early language development . Method : Data were collected as part of a prospect i ve longitudinal study of 110 VPT ( VPT : ≤33 weeks gestation ) and 113 full-term children ( full term : 37–41 weeks gestation ) born in Canterbury , New Zeal and from 1998 to 2000 . At corrected age 4 years , all children were assessed with the preschool version of the Clinical Evaluation of Language Fundamentals . Extensive information was also collected about children 's family social background , perinatal health , childrearing environment , education/intervention exposures , and neurodevelopmental progress from birth to age 4 . Results : At the age of 4 years , VPT children were characterized by poorer receptive and expressive language development than full-term children . These differences persisted after exclusion of children with neurosensory impairment as well as statistical adjustment for the effects of social risk . Within the VPT group , the key predictors of children 's overall language development were family social risk at birth ( p = .05 ) , severity of white matter abnormalities on neonatal magnetic resonance imaging ( p = .49 ) , observed parent-child synchrony ( p = .001 ) , and concurrent child cognitive ability ( p = .001 ) . Together , these factors accounted for 45 % of the variance in children 's total Clinical Evaluation of Language Fundamentals — Preschool scores . Conclusion : By preschool age , children born VPT  show early emerging mild to moderate language delays that are likely to affect their school success and longer-term developmental progress . Findings highlight the importance of potentially modifiable factors such as early brain injury and parenting quality in predicting the language outcomes of children born VPT The objective of this analysis was to examine the effect of low birth weight and prematurity on bronchial air-flow , bronchial reactivity , airway symptoms and asthma diagnosis at school age . A cross-sectional epidemiological study was performed in three small towns in the eastern part of Germany on 2470 school children aged 5 - 14 ( 89.1 % of eligible children ) . A 78 item question naire to determine risk factors at birth and in early childhood was employed . 7.8 % of the children were born before completing 38 gestational weeks ; 6.6 % had a birth weight less than 2500 g.  Pulmonary function analysis were done by a mobile plethysmography at the school . There were only weak restrictions in lung volume in term low birth weight ( LBW ) children ( 100 ml lower TLC , p = 0.107 ) , and flow ( 257 ml lower PEFR , p = 0.108 ) , were low . However , bronchial hyper-responsiveness indicated by 292 ml lower FEV1.0 after cold air bronchial provocation , was significantly increased compared to term normal birth weight children ( p < 0.001 ) . The effect of LBW was less in older children , only slightly stronger in girls and increased in children mechanically ventilated during the postnatal period . Correspondingly , there was a higher prevalence of diagnosed asthma in term LBW children ( OR 1.6 , 95%-confidence interval 1.0 - 2.6 ) , however these were without an increased risk for any allergic sensitization . LBW , therefore , seems to be a risk factor for smaller lungs and hyperreactive airways primarily in term born children , whereas in preterm children the immature bronchial system seems to be recover by school age BACKGROUND Educational underachievement is a major morbidity associated with very preterm ( VPT ) birth . However , few studies have examined early school outcomes with most employing global , clinic based measures . OBJECTIVE To examine the early school achievement in a cohort of children born VPT and studied to age 6 years . METHODS A regional cohort of 102 VPT children ( < /=33 weeks GA ) were followed prospect ively alongside a comparison group of 108 full term ( FT ) children born during the same period ( 1998 - 2000 ) . At 6 years corrected age , all children underwent a comprehensive neurodevelopmental evaluation that included the Woodcock-Johnson Tests of Achievement ( WJ-III ) , teacher report and national numeracy and literacy test results . Rates of specific learning disabilities ( LD ) were also examined . RESULTS VPT children performed less well than FT children on WJ-III subtests ( ps<.05 ) , national tests ( ps<.01 ) , and in all curricular areas rated by teachers ( ps<.01 ) except expressive language . Even VPT children without severe neurodevelopmental impairment scored lower on the WJ-III math , national tests ( ps<.05 ) and were 2 - 3 times more likely to show delays ( ps<.02 ) in math ( 43 % vs. 19 % ) , written language ( 36 % vs. 22 % ) , language comprehension ( 26 % vs. 14 % ) , h and writing ( 36 % vs. 17 % ) , spelling ( 38 % vs. 30 % ) and physical education ( 33 % vs. 11 % ) . They were also twice as likely as FT children to have math LD ( 47 % vs. 21 % ) . CONCLUSIONS By age 6 , a substantial proportion of VPT children are lagging behind their FT peers across multiple curriculum areas , with difficulties being most prominent in math . Findings highlight the need for early identification and educational supports to help maximise VPT children 's learning opportunities during the transition to school
premature infants are more susceptible to motor development , behavior and academic performance impairment when compared to term infants .
OBJECTIVES to examine and synthesize the available knowledge in the literature about the effects of preterm birth on the development of school-age children .