Usefulness of the most popular neurodevelopmental tests in preschool assessment of children born with very low birth weight.

BACKGROUND: The aim of our study was multifaceted neurodevelopmental examination of children born prematurely with very low birth weight (VLBW) in order to evaluate the usefulness of popularly used tests. The second aim of the study was exploration of risk and protective factors of neurodevelopmental impairment. METHODS: Eighty-nine VLBW patients were evaluated at the age of 50 months. All children underwent anthropometric measurements and psychomotor tests: functional independence measure scale (WeeFIM), Gross Motor Function Measurement (GMFM), non-verbal psychometric evaluation (Leiter test), Developmental Test of Visual Perception (DTVP-2), temperament questionnaire (EAS-C) and children vocabulary test (TSD). RESULTS: Most severe deficits in ex-preterms' neurodevelopment were associated with verbal abilities, visual perception and temper abnormalities. WeeFIM, DTVP-2, Leiter and vocabulary tests' results correlated with each other. The lowest percent of children with deficits in WeeFIM test indicates, that it seems to be the most valuable tool for identification of the most seriously impaired children. Due to the highest percent of children with visual perception deficits, DTVP test seems to be good second choice in assessment of children born prematurely. In motor assessment GMFM appears to be more adequate than cerebral palsy (CP) diagnosis. Almost one fifth of VLBW did not reach 85% in Gross Motor Function Measurement, although only 9% of children had CP. CONCLUSIONS: Children born with VLBW had deficits in every part of psychometric evaluation. We believe that the most useful tests in assessment VLBW patients are WeeFIM, GMFM and DTVP. Children with severe prematurity complications could require more precise evaluation.

Temperament traits in 4-year-old children born prematurely - may they suggest a threat for mental functioning? / Cechy temperamentalne u czteroletnich dzieci urodzonych przedwczesnie ­ czy moga sugerowac zagrozenie w funkcjonowaniu psychicznym?

OBJECTIVES: The aim of the study was to assess emotional functioning and identification of temperamental traits in 4-year-old children born prematurely with birth weight =< 1500 grams. The second aim was evaluation of autism spectrum disorders frequency in this group of children. METHODS: Eighty-six 4-year-old children born prematurely (gestational age =< 32 weeks, birth weight =< 1500 grams) were evaluated. All children underwent physical examination (with the assessment of motor function, vision and hearing), anthropometric measurements and psychomotor tests: Leiter International Performance Scale P-93, Children Vocabulary Test (TSD), temperament questionnaire (EAS-C), and CAST questionnaire. Parents were asked to fill in questionnaires assessing socio-economic conditions of the family and children attendance in kindergarten or early development support. RESULTS: In the EAS-C questionnaire hyperactivity and reduced emotionality were significantly more common comparing to population. Children with lower gestational age and lower birth weight were characterized with low emotionality score. Children with the CAST score ? 12 points were significantly smaller at birth, more often suffered from retinopathy of prematurity and had poorer results in neurodevelopmental tests - Leiter scale, Children Vocabulary Test. CONCLUSIONS: Children born prematurely are at greater risk of the occurrence of hyperactivity and autism spectrum symptoms. Detection of emotional disorders in children born prematurely is essential to implement the therapeutic support as early as possible.

The Use of d2 and Benton Tests for Assessment of Attention Deficits and Visual Memory in Teenagers with Phenylketonuria.

Hyperphenylalaninemia-related, subtle deficits of attention and of working memory are often reported in adolescents with phenylketonuria. Focused neuropsychological tests can be used to detect such deficits and to confirm the presence of poor metabolic control in the periods between routine blood phenylalanine tests, which are rarely performed in many patients from this age group due to their low treatment adherence.We assessed the practical value of the d2 test of attention and of the Benton visual retention test for identification of teenagers, who have a high risk of brain dysfunction due to hyperphenylalaninemia. We analyzed the correlation between neuropsychological test scores achieved by 30 patients and their blood phenylalanine profiles since the neonatal period.We observed strong correlation between the Concentration Performance scores on the d2 test and the quality of metabolic control within last month prior to the follow-up visit in the outpatient clinic (r = -0.72; p = 0.0003). The mean z-score was significantly higher in patients with good metabolic control than in those with poorly controlled hyperphenylalaninemia (0.44 vs. -1.12; p = 0.00002). On contrary, the results of the Benton visual retention test did not correlate significantly with the individual blood phenylalanine profiles.We believe that neuropsychological assessment should be used in adolescents with phenylketonuria on a regular basis in order to increase the self-awareness in these patients and, consequently, to increase their treatment adherence and safety. The d2 test can be effectively used for detection of attention deficits and seems to be a valuable supplementary procedure for routine follow-up.

Microstructure changes of occipital white matter are responsible for visual problems in the 3-4-year-old very low birth weight children.

PURPOSE: The main aim of the study was to evaluate which factors affect the long-time visual function in preterm children, whether it is prematurity or retinopathy of prematurity or perhaps disturbances in the visual pathway. MATERIALS AND METHODS: Fifty-eight children with mean birth weight 1016 g (range 520-1500 g) were evaluated at mean age 48 months (range 42-54 months). All children underwent magnetic resonance imaging (MRI) studies, visual evoked potentials (VEPs), and the Developmental Test of Visual Perception (DTVP). The MRI evaluation included diffusion tensor imaging and fractional anisotropy (FA), and colored orientation maps were calculated for each subject. Based on the results of the VEP evaluation, children were divided into two groups: A-abnormal results of VEP (n = 16) and B-normal VEP results (comparison group, n = 42). RESULTS: FA values of inferior left and right occipital white matter (OWM) were lower in the group of children with abnormal VEP compared to the comparison group (0.34 ± 0.06 vs. 0.38 ± 0.06; P = 0.047; 0.31 ± 0.04 vs. 0.36 ± 0.06; P = 0.007, respectively). Furthermore, there were correlations between the latency (r = -0.35; P = 0.01) and amplitude (r = 0.31; P = 0.02) and FA in OWM. Children with abnormal VEP had lower DTVP scores as compared with children with normal VEP results (88 ± 18 vs. 95 ± 16 points, P = 0.048). Finally, a multivariate logistic regression revealed that FA of the inferior OWM was the only independent risk factor for the abnormal VEP (P = 0.04). CONCLUSION: Visual perception, VEPs, and white matter microstructural abnormalities in very low birth weight children at the age of 3-4 are significantly correlated.

Ocular outcomes in 4-year old prematurely born children.

Purpose: The aim of the study was to assess functional and structural ophthalmologic outcomes in 4-year old very low birth weight children (VLBW). Material and Methods: A group of 82 VLBW children including: (1) children without retinopathy of prematurity ­ group O (n = 30), (2) children with retinopathy of prematurity with no indications for laser coagulation- group 1 (n = 20 ), (3) children with retinopathy of prematurity treated with laser coagulation ­ group 2 (n = 32) were enrolled. Functional (visual acuity, visual evoked potentials, stereopsis, color vision test) and structural (anterior eye segment examination and fundoscopy) outcome, cycloplegic refraction, intraocular pressure and angle of squint were examined in all children. Developmental Test of Visual Perception was also assessed. Results: Very good visual acuity was presented in 56 (68.3%) patients, good visual acuity in 11 (13.4%) children, visual acuity between 0.4 and 0.2 in 13 (15.9%) and unfavorable function (equal or less than 0.1) was observed in 2 (2.4%) children. Twenty-three patients (28.1%) were myopic, 57 patients (69.5%) were hyperopic. Astigmatism > 1D occurred in 49 (59.8%) patients. Anisometropia larger than 2 D occurred in 7 patients (8.7%). There was no statistical difference between frequency of mentioned above complications between the groups. Abnormal VEP results were more common (14 children -54%) in group 2 as compared to other groups (group 0 - 7 children -25%, group 1 ­ 4 children -24%; p = 0.044). Moreover, the lower percentage of group 2 children presented stereopsis vision (46.9%, group 0 ­ 93.3%, group 1 ­ 90%; p<0.05). Children with retinopathy of prematurity treated with laser coagulation had significantly lower Developmental Test of Visual Perceptions scores. In group 1, in 1 child naevus pigmentosus of the eyelid was observed, in group 2 in one child eyeball atrophy in the right eye and aphakia in the left eye were diagnosed. In 1 child in group 0 optic disc drusen were observed, in 2 children optic discs were pale. In 2 children in group 2 retinal detachment stage 5 was diagnosed. Conclusion: An important factor affecting final ophthalomolgical assessment in prematurely born children is retinopathy of prematurity treated with laser coagulaion. Children with retinopathy of prematurity without laser coagulation had examinations results comparable wih children without retinopathy of prematurity. Diode laser photocoagulation is an effective method of treatment fot active stages of retinopathy of prematurity.

Relationship between Proton Magnetic Resonance Spectroscopy of Frontoinsular Gray Matter and Neurodevelopmental Outcomes in Very Low Birth Weight Children at the Age of 4.

Very low birth weight is associated with long term neurodevelopmental complications. Macroscopic brain abnormalities in prematurity survivors have been investigated in several studies. However, there is limited data regarding local cerebral metabolic status and neurodevelopmental outcomes. The purpose of this study was to characterize the relationship between proton magnetic resonance spectra in basal ganglia, frontal white matter and frontoinsular gray matter, neurodevelopmental outcomes assessed with the Leiter scale and the Developmental Test of Visual Perception and selected socioeconomic variables in a cohort of very low birth weight children at the age of four. Children were divided in three groups based on the severity of neurodevelopmental impairment. There were no differences in spectroscopy in basal ganglia and frontal white matter between the groups. Lower concentrations of N-acetylaspartate (NAA), choline (Cho) and myoinositol (mI) were observed in the frontoinsular cortex of the left hemisphere in children with neurodevelopmental impairment compared to children with normal neurodevelopmental outcomes. Higher parental education, daycare attendance and breastfeeding after birth were associated with more favorable neurodevelopmental prognosis, whereas rural residence was more prevalent in children with moderate and severe impairment. Our study demonstrates the role of long term neurometabolic disruption in the left frontoinsular cortex and selected socioeconomic variables in determination of neurodevelopmental prognosis in prematurity survivors.

Relationship between Stereoscopic Vision, Visual Perception, and Microstructure Changes of Corpus Callosum and Occipital White Matter in the 4-Year-Old Very Low Birth Weight Children.

AIM: To assess the relationship between stereoscopic vision, visual perception, and microstructure of the corpus callosum (CC) and occipital white matter, 61 children born with a mean birth weight of 1024 g (SD 270 g) were subjected to detailed ophthalmologic evaluation, Developmental Test of Visual Perception (DTVP-3), and diffusion tensor imaging (DTI) at the age of 4. RESULTS: Abnormal stereoscopic vision was detected in 16 children. Children with abnormal stereoscopic vision had smaller CC (CC length: 53 ± 6 mm versus 61 ± 4 mm; p < 0.01; estimated CC area: 314 ± 106 mm(2) versus 446 ± 79 mm(2); p < 0.01) and lower fractional anisotropy (FA) values in CC (FA value of rostrum/genu: 0.7 ± 0.09 versus 0.79 ± 0.07; p < 0.01; FA value of CC body: 0.74 ± 0.13 versus 0.82 ± 0.09; p = 0.03). We found a significant correlation between DTVP-3 scores, CC size, and FA values in rostrum and body. This correlation was unrelated to retinopathy of prematurity. CONCLUSIONS: Visual perceptive dysfunction in ex-preterm children without major sequelae of prematurity depends on more subtle changes in the brain microstructure, including CC. Role of interhemispheric connections in visual perception might be more complex than previously anticipated.

[Assessment of somatic development and body composition in the 7th year of life in children born as extremely low birth weight infants (≤1000g); a multi-centre cross-sectional study of a cohort born between 2002 and 2004 in the Malopolska voivodship]. / Ocena rozwoju somatycznego i skladu ciala dzieci w 7. roku zycia urodzonych z ekstremalnie mala masa ciala (≤1000 g)--wieloosrodkowe badanie przekrojowe kohorty urodzonej w latach 2002-2004 w województwie malopolskim.

UNLABELLED: Children born with extremely low birth weight often present delayed growth in the first years of their lives: they remain shorter and weigh less than their peers. Current reports published worldwide state that later in life these children are at an increased risk of cardiac and vascular diseases, diabetes and obesity. Abnormal distribution and the excess of fat tissue predispose them to develop the metabolic syndrome. THE AIM of the study was to evaluate the somatic development of seven-year-old children born with birth-weight ≤1000 g (ELBW) in the Malopolska voivodship and to estimate the content and distribution of fat tissue. Moreover, the risk factors of disturbed somatic development were evaluated. MATERIALS AND METHODS: Two hundred and four live newborns with birth weight ≤1000 g were born in the Malopolska voivodship between 1.09.2002 and 31.08.2004. One hundred and fifteen of these children (56%) died in early infancy. The study included 81 children in the 7th year of life out of the 89 surviving ones. Their mean gestational age at birth was 27.3 weeks. (SD: 2.1 weeks) and their mean birth-weight was 840 g (SD: 130 g). All the children underwent anthropometric measurements and the thickness of the skin fold over the triceps was measured. Body mass index (BMI) was calculated and the body composition was assessed by multifrequency bioimpedance. The control group consisted of 39 children born at term chosen randomly from the general population and matched with regard to age and sex. RESULTS: The ELBW children in the 7th year of life were shorter (z-score: -1.06±1.4 p<0.001), had lower body mass (z-score: -0.57±0.9; p=0.01), smaller head circumference (z-score: -1.2±1.3; p<0.001), lower BMI (z-score: -0.99±1.6; p<0.001) as compared to their peers. Fat tissue mass was lower in the ELBW group than in the control group (11% vs 16%; p<0.01). The most retarded somatic development was observed in the group of children suffering from cerebral palsy. CONCLUSIONS: 1. Children born with ELBW, at 7 years of life, present significantly retarded somatic development as compared with their full-term peers. 2. The most important risk factor of somatic development disturbances is cerebral palsy. 3. Children born with low birth weight and ELBW, need long term follow up.

[Intellectual and motor development of extremely low birth weight (≤1000 g) children in the 7th year of life; a multicenter, cross-sectional study of children born in the Malopolska voivodship between 2002 and 2004]. / Rozwoj poznawcyz i motoryczny w 7 roku zycia dzieci urodzonych z ekstremalnie mala masa ciala (≤1000 G) - wieloosrodkowe badanie przekrojowe dzieci urodzonych w latach 2002-2004 w wojewodztwie malopolskim.

INTRODUCTION: A better understanding of the developmental problems in extremely low birth weight (ELBW) preterm infants may enhance their chances of proper adaptation to their environment and make it possible to retrospectively assess perinatal and neonatal methods of treatment. The aim of the study was to evaluate the cognitive and motor development of ELBW children born from 2002 to 2004 in the 7th year of life. Based on these results and perinatal mortality data, it was established what chance the children have to live free of severe complications. MATERIAL AND METHODS: Two hundred and four alive newborns with birth weight .1000 g were born in the Malopolska voivodship between 1.09.2002 and 31.08.2004. One hundred and fifteen children (56%) died in early infancy. The study included 81 (91%) children out of the 89 surviving ones. Their mean gestational age at birth was 27.3 weeks. (SD: 2.1 weeks) and their mean birth weight was 840g (SD: 130g). Neurosensory disturbances were assessed in all the children and their cognitive development was evaluated with the use of the WISC-R (Wechsler Intelligence Scale for Children . Revised) scale. The children were divided into 3 groups: group I . normal development (full motor capacity and IQ >84 points and no vision or hearing impairment), group II . mild or moderate impairment (cerebral palsy level I, II or III according to the Gross Motor Function Classification System [GMCS], or IQ 40-84 points, or abnormal vision or hearing, or signs of the hyperactivity syndrome), group III . severe impairment (cerebral palsy level IV, and/or IQ <40 points, or deafness/blindness). RESULTS: Forty-five (56%) children were included in group I, 25 (30%) in group II and 11 (14%) in group III. Moreover, other neurologic abnormalities, such as uneven development, problems with concentration, or abnormal grapho-motor ability were highly prevalent in the group of ELBW children. The incidence of cerebral palsy in the population studied was 16%, the incidence of deafness and severe hearing impairment was 11%, and blindness and severe vision impairment . 12%. In general, the chance of survival free of severe complications was merely 15% in children with birthweight .700 g, 28% in children with birth weight 701- 800 g, 45% in children with birth weight 801-900 g, and 62% in children with birth weight 901-1000 g. CONCLUSIONS: 1. The data gathered in a regional study may yield valuable information useful in assessing the prognosis of the general health status of ELBW newborns. 2. Most of the children present uneven development, problems with concentration, or abnormal grapho-motor ability, which may be a cause of learning problems and abnormal relationships with peers. 3. A follow-up study up to adulthood is required for this group of ELBW newborns.

[Psychomotor development at the age of 5-7 years of very low birth weight infants]. / Ocena rozwoju psychoruchowego w wieku 5 -7 lat dzieci urodzonych z bardzo mala masa ciala.

BACKGROUND: Very low birth weight (VLBW) infants are at greater risk for neurodevelopmental delay, cerebral palsy (CP), vision and hearing impairment, and cognitive and emotional problems. The aim of the study was assessment of neurodevelopmental outcomes at the age of 5-7 years among VLBW infants and evaluation of prognostic value of selected perinatal risk factors. MATERIAL AND METHODS: A sample of 73 VLBW infants with mean birtweight 1075g and mean gestational age 28.9 weeks were evaluated. Infants were divided into 3 groups: (A) normal development (n = 35; 48%), (B) mild-to-moderate impairment (IQ 68-83, or mild to moderate hearing loss or visual problems, or mild/moderate CP or ADHD) (n = 25; 36%) and (C) severe impairment (IQ < 68, deafness, blindness or severe CP) (n = 13; 18%) RESULTS: The studied groups differ in respect to: gestational age (mean +/- SEM: 29.7 +/- 2.3 vs 28.1 +/- 2.5 vs 28.5 +/- 2.3 wks; p = 0.03), prevalence of retinopathy (ROP) (17 vs 28 vs 69%; p < 0.01), bronchopulmonary dysplasia (BPD) (31 vs 17 vs 62%; p = 0.03) and periventricular leukomalacia (PVL) (3 vs 0 vs 23%; p < 0.02). Maximum bilirubin concentration was higher in children with severe impairment (mean +/- SEM: 177 +/- 60 vs 193 +/- 45 vs 229 +/- 48 micromol/l; p < 0.05). On multivariate logistic regression analysis, factors associated with developmental impairment were serum bilirubin > or = 200 micromol/ I and ROP. CONCLUSIONS: The significant risk factors of poor neuro-developmental outcomes at the age of 5-7 years among VLBW infants are: gestational age, PVL, ROP, BPD and serum bilirubin concentration > 200 micromol/I.