Growth of preterm and full-term children aged 0-4 years: integrating median growth and variability in growth charts.

OBJECTIVES: To assess the distribution of height, weight, and head circumference (HC) in preterm infants for ages 0-4 years, by gestational age (GA) and sex, and to construct growth reference charts for preterm-born children, again by GA and sex, for monitoring growth in clinical practice. STUDY DESIGN: The community-based cohort study covered a quarter of The Netherlands. 1690 preterm infants (GA, 25-35(+6) weeks) and a random sample of 634 full-term control infants (GA 38-41(+6)), who were followed from birth to 4 years of age. Height, weight, and HC were regularly assessed during routine well-child visits and data were retrospectively collected. RESULTS: At all ages, the median height and weight of preterm children were lower compared with full-term children. Growth depended on the child's GA. Increase in HC showed an early catch-up and was similar to full-term children by the age of 1. Height, weight, and HC were more variable in boys, particularly in the very preterm children. CONCLUSIONS: At 0 to 4 years, the growth of preterm children differed from that of full-term children and depended on their GA. The greater variability of growth in boys suggests that they are more vulnerable to the complications of preterm birth that influence growth. These growth charts are the most precise tools currently available for monitoring growth in preterm children.

Developmental delay in moderately preterm-born children at school entry.

OBJECTIVE: To determine the prevalence and nature of developmental delay at preschool age in infants born moderately preterm compared with those born full-term and early preterm. STUDY DESIGN: Parents of 927 moderate preterm infants (32-35(+6) weeks gestation), 512 early preterm infants (<32 weeks gestation) and 544 full-term infants (38-41(+6) weeks gestation) completed the Ages and Stages Questionnaire (ASQ) when the child was aged 43-49 months. We analyzed rates of abnormal ASQ scores and odds ratios for abnormal ASQ scores in both preterm groups compared with the full-term group. We repeated the analyses after adjustment for socioeconomic status, sex, being part of a multiple birth, and small for gestational age status. RESULTS: Abnormal (ie, >2 SDs below the mean) ASQ total scores were noted in 8.3% of moderate preterm infants, in 4.2% of full-term infants, and in 14.9% of early preterm infants. ORs of abnormal ASQ total scores were 2.1 (95% CI, 1.3-3.4) for moderate preterm infants and 4.0 (95% CI, 2.4-6.5) for early preterm infants. Both moderate and early preterm infants had more frequent problems with fine motor, communication, and personal-social functioning compared with full-term infants. Compared with full-term infants, moderate preterm infants did not have a greater prevalence of problems with gross motor functioning and problem solving, whereas early preterms did. Socioeconomic status, small for gestational age status, and sex were associated with abnormal ASQ scores in moderate preterm infants. CONCLUSIONS: At preschool age, the prevalence of developmental delay in moderate preterm infants was 2-fold of that in full-term infants and one-half of that in early preterm infants.

Support for the global feasibility of the Ages and Stages Questionnaire as developmental screener.

OBJECTIVE: To investigate the psychometric properties of the Dutch version of the 48 months Ages and Stages Questionnaire (D_ASQ_48). DESIGN: Prospective cohort study of a community-based sample of children born in 2002 and 2003 whose parents filled out the D_ASQ_48 and a questionnaire on school status at 60 months. The ASQ was translated into Dutch and back-translated into English by three independent translators. SETTING: Well Child Centers covering 25% of the Netherlands. PARTICIPANTS: Parents of 1510 preterm and 562 term children born in 2002-2003 attending routine Well Child visits at age 45-50 months. MAIN OUTCOME MEASURES: Reliability, validity and mean population scores for D_ASQ_48 compared to other countries. RESULTS: Mean population scores for the D_ASQ_48 were mostly similar to those in the USA, Norway and Korea. Exceptions (effect sizes of difference >0.5) were problem solving (USA) and fine motor (Korea). Reliability was good for the total score (Cronbach alpha 0.79) and acceptable for all domains (0.61-0.74). As expected, infants born at gestational age <32 weeks, children from low income families, of low educated mothers, and boys were more likely to fail on several domains (odds ratios, OR ranging from 1.5 to 4.9). The only unexpected association concerned children from one-parent families. Sensitivity to predict special education at five years of age was 89% and specificity 80%. CONCLUSIONS: The good psychometric properties of the Dutch ASQ_48 and the small differences when compared to other countries support its usefulness in the early detection of developmental problems amongst children worldwide.

Predicting early failure after adjuvant chemotherapy in high-risk breast cancer patients with extensive lymph node involvement.

PURPOSE: There is limited knowledge of risk factors for breast cancer recurrence within 2 years. This study aimed to predict early failure and identify high-risk patients for prognostic and therapeutic purposes. EXPERIMENTAL DESIGN: We studied 739 patients from a randomized trial who were <56 years of age and had >/=4 or more positive lymph nodes, no distant metastases, and no previous other malignancies. After complete surgical treatment, patients received conventional-dose anthracycline-based chemotherapy or a high-dose scheme of anthracycline-based plus alkylating chemotherapy. We assessed clinical and (immuno)histological parameters to predict recurrence within 2 years. RESULTS: Early failure occurred in 19% (n = 137). Median survival after early failure was limited to 0.7 year. Estrogen and progesterone receptor negativity and visceral relapse predicted poor prognosis. Early failure was associated with young age, large tumors, high histological grade, angio-invasion, apical node metastasis, and >/=10 involved nodes. Estrogen receptor, progesterone receptor, and p27 negativity; HER2 overexpression; and p53 positivity also predicted early failure. The surgical or chemotherapy regimen and histological type did not. The same parameters except tumor size were associated with early death. Grade III, >/=10 involved nodes, and estrogen receptor negativity were independently associated with early failure and together identified a subset of patients (7%) with 3-fold increased early failure and 5-fold increased early death. CONCLUSIONS: Early failure is associated with poor survival. The combination of three commonly determined parameters constitutes a strong predictive model for early failure and death.