The childhood respiratory consequences of very low birth weight (birth weight < or =1,500 g) are incompletely understood, especially since the introduction of recent changes in neonatal care. To assess prevalence, trends, and risk factors for respiratory symptoms, the authors followed to age 8 years a cohort of 384 very low birth weight children from six regional neonatal intensive care units in Wisconsin and Iowa who were born between August 1, 1988, and June 30, 1991. A control group of 154 Wisconsin schoolchildren was also assembled. Respiratory symptoms in the past 12 months and history of asthma ("asthma ever") were reported by parents on a questionnaire used in the International Study of Asthma and Allergies in Childhood (ISAAC). Control group prevalence resembled ISAAC prevalence worldwide and in Canada, but respiratory symptoms were twice as common among very low birth weight children. With advent of the availability of pulmonary surfactants, the prevalence of wheezing at age 8 decreased from 50% to 16% (p = 0.002) among children with bronchopulmonary dysplasia, but it increased from 14% to 38% among those with milder neonatal respiratory disease. Bronchopulmonary dysplasia, family history of asthma, smoking in the household, and patent ductus arteriosus were predictive of wheezing in the previous 12 months. Antenatal steroid therapy had a borderline-significant protective association with wheezing (odds ratio = 0.56, 95% confidence interval: 0.29, 1.1). There were interaction effects between several of the predictors.

Background Individuals with type 1 diabetes may have low IGF-1, related to insulinopenia and insulin resistance. There are few longitudinal studies of IGF-1 levels to establish its pattern in type 1 diabetes with duration and age, and to examine whether IGF-1 tracks within individuals over time. We examine age and duration trends, and the relationship of IGF-1 to gender, glycemic control, insulin level and other factors. Methods Participants in the Wisconsin Diabetes Registry Study, an incident cohort study of type 1 diabetes diagnosed May 1987-April 1992, were followed for up to 18 years with IGF-1 samples up to age 45 for women and age 37 for men.. Results IGF-1 is lower with type 1 diabetes than in normative samples. Although, the pattern across age resembles that in normative samples with a peak in adolescence and slow decline after age 20, the adolescent peak is delayed for women with type 1 diabetes. There was low to moderate tracking of IGF-1 within individual. Higher insulin dose was associated with higher IGF-1 as was puberty, and female gender. Adjusted for these factors, IGF-1 declined rapidly across early diabetes duration. Lower HbA1c was most strongly related to higher IGF-1 at Tanner stages 1 and 2. Conclusions IGF-1 is low in type 1 diabetes, with a delayed adolescent peak in women and is especially influenced by glycemic control in early and pre- adolescence. High variability within individual is likely a challenge in investigating associations between IGF-1 and long term outcomes, and may explain contradictory findings.

BackgroundThe Individuals with Disabilities Education Act (Part C) authorizes states to establish systems to provide early intervention services (e.g., therapy) for children at risk, with the incentive of federal financial support. This study examines family and neighborhood characteristics associated with currently utilizing physical, occupational, or speech therapy among very low birthweight (VLBW) 2-year-old children who meet Wisconsin eligibility requirements for early intervention services (EI) due to developmental delay.MethodsThis cross-sectional analysis used data from the Newborn Lung Project, a regional cohort study of VLBW infants hospitalized in Wisconsin’s newborn intensive care units during 2003–2004. We included the 176 children who were age two at follow-up, and met Wisconsin state eligibility requirements for EI based on developmental delay. Exact logistic regression was used to describe child and neighborhood socio-demographic correlates of parent-reported receipt of therapy.ResultsAmong VLBW children with developmental delay, currently utilizing therapy was higher among children with Medicaid (aOR = 5.3, 95% CI: 1.3, 28.3) and concomitant developmental disability (aOR = 5.2, 95% CI: 2.1, 13.3) and lower for those living in a socially more disadvantaged neighborhood (aOR=0.48, 95% CI: 0.21, 0.98, per tertile).ConclusionsAmong a sample of VLBW 2-year olds with developmental delays who are EI-eligible in WI, 4 out of 5 were currently receiving therapy, per parent report. Participation in Medicaid positively influences therapy utilization. Children with developmental difficulties who live in socially disadvantaged neighborhoods are at highest risk for not receiving therapy.

Objective-Permissive hypercapnia is a respiratory care strategy used to reduce the risk of lung injury. The goal of this study was to evaluate whether permissive hypercapnia is associated with higher risk for intraventricular hemorrhage (IVH) and early childhood behavioral and functional problems than normocapnia among very low birthweight (VLBW) infants.Patients and Methods-VLBW infants from a statewide cohort were eligible for this study if they were born <32 weeks gestational age and survived at least 24 hours. Infants were classified as receiving a permissive hypercapnia (N=122), normocapnia (N=235), or unclassifiable (N=791) respiratory strategy during the first 24 hours after birth according to an algorithm based on PCO 2 values and respiratory treatment decisions abstracted from medical records. IVH diagnosis was also abstracted from the medical record. Behavioral and functional outcomes were assessed by parent interview at 2-3 years. Logistic regression was used to evaluate the relationship between IVH and respiratory strategy; ordinary linear regression was used to evaluate differences in behavior and function scores between children by respiratory strategy.Results-Infants who received a permissive hypercapnia strategy were not more likely to have IVH than those with normocapnia (odds ratio=1.0, 95% confidence interval: 0.59, 1.8). There were no differences in any of the behavioral or functional scores between children by respiratory strategy. There was a significant interaction between care strategy and one-minute Apgar score, indicating that infants with lower Apgar scores may be at higher risk for IVH with permissive hypercapnia.Conclusion-This study suggests permissive hypercapnia does not increase risk for brain injury and impairment among VLBW children. The interaction between respiratory strategy and Apgar score is a potential worrisome exception to this conclusion. Future research should further evaluate the effect of elevated PCO 2 levels among those sickest at birth. KeywordsPermissive hypercapnia; developmental follow-up; intraventricular hemorrhage; VLBW-very low birthweight Very low birthweight (VLBW, <1500g) infants are often premature with incompletely developed respiratory systems, and most require respiratory assistance for survival. Despite the suggested benefit of permissive hypercapnia for decreasing risk of BPD, it is not well understood whether it is associated with risk of brain injury, such as intraventricular hemorrhage (IVH), and subsequent developmental impairment. IVH was evaluated as a secondary outcome in two clinical trials of permissive hypercapnia. 5,6 Neither trial found any relationship between permissive hypercapnia and risk of IVH, but the first 5 had a small sample size (n=49) and the second 6 was terminated early with a smaller than planned sample (n=220). A trial that targeted even higher PaCO 2 levels found that, at 18-22 months, children in this minimal ventilation group had worse scores on the Bayley mental developmental index than children randomized t...

Children born very low birthweight (VLBW, <=1500 g) have historically had lower average school achievement than their normal birthweight peers. However, perinatal care and survival have changed dramatically since prior cohorts accrued, prompting reassessment. Surfactant therapy became generally available 8/1/1990, and the use of ante- and postnatal steroids increased substantially around this time. Standardized test scores and teacher ratings in math, reading, science, and social studies were obtained at age 10 for a cohort of children admitted to six regional NICUs in Wisconsin and Iowa, 8/1/1988 - 6/30/1991. We compared achievement between the VLBW cohort and controls from the same school districts. Among VLBW children, we determined neonatal and early childhood factors associated with achievement on standardized tests (ordinal logistic regression) and teacher ratings (linear regression) and evaluated whether achievement differed by birth year. Compared to population controls, VLBW children's greatest deficits occurred in mathematics. Scores on the standardized math exam and teacher ratings of overall achievement were positively associated with birthweight, social function measured at age five, and socioeconomic status. VLBW children born in the post-surfactant era (after 8/1/1990) had lower achievement on the standardized math exam than children born during the pre-surfactant era of the prior two years. Lower achievement in the post-surfactant era may be due to greater survival among less healthy neonates or increased exposure to postnatal steroids. VLBW children more likely to struggle academically could be identified by early childhood measures, allowing for targeted interventions to mitigate their difficulties.