Motor and Cognitive Outcomes in Nondisabled Low-Birth-Weight Adolescents

Whitaker, Agnes H.; Feldman, Judith F.; Lorenz, John M.; Shen, Sa; McNicholas, Fiona; Nieto, Marlon; McCulloch, Dawn; Pinto‐Martin, Jennifer; Paneth, Nigel

doi:10.1001/archpedi.160.10.1040

Cited by 83 publications

(74 citation statements)

References 44 publications

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“…Our aim was to explore in a prospective cohort of premature newborns serially studied with diffusion tensor imaging, the associations of established risk factors for motor impairment with development of the major motor pathway measured with diffusion tensor tractography. These risk factors include antenatal exposures, such as pregnancy-induced hypertension [6], gestational diabetes [7], and intrauterine inflammation [8][9][10], as well as male sex [11][12][13]. Putative perinatal and post-natal risk factors include early illness severity as measured by the Score of Neonatal Acute Physiology-Version II (SNAP-II) [14,15], infection [9,16,17], necrotizing enterocolitis [16,17], patent ductus arteriosus [18], chronic lung disease [18][19][20][21], and neonatal procedural pain [22].…”

Section: Introductionmentioning

confidence: 99%

Score for Neonatal Acute Physiology–II and Neonatal Pain Predict Corticospinal Tract Development in Premature Newborns

Zwicker¹,

Grunau²,

Adams³

et al. 2013

Pediatric Neurology

116

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Premature infants are at risk for adverse motor outcomes, including cerebral palsy and developmental coordination disorder. The purpose of this study was to examine the relationship of ante-, peri-, and postnatal risk factors for abnormal development of the corticospinal tract, the major voluntary motor pathway, during the neonatal period. In a prospective cohort study, 126 premature neonates (24-32 weeks gestational age) underwent serial brain imaging near birth and at term-equivalent age. Using diffusion tensor tractography, mean diffusivity and fractional anisotropy of the corticospinal tract were measured to reflect microstructural development. Generalized estimating equation models examined associations of risk factors on corticospinal tract development.The perinatal risk factor of greater early illness severity [as measured by the Score for Neonatal Acute Physiology-II (SNAP-II)] was associated with a slower rise in fractional anisotropy of the corticospinal tract (p=0.02), even after correcting for gestational age at birth and postnatal risk factors (p=0.009). Consistent with previous findings, neonatal pain adjusted for morphine and postnatal infection were also associated with a slower rise in fractional anisotropy of the corticospinal tract (p=0.03 and 0.02 respectively). Lessening illness severity in the first hours of life might offer potential to improve motor pathway development in premature newborns.

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Section: Introductionmentioning

confidence: 99%

Score for Neonatal Acute Physiology–II and Neonatal Pain Predict Corticospinal Tract Development in Premature Newborns

Zwicker¹,

Grunau²,

Adams³

et al. 2013

Pediatric Neurology

116

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“…Mean FSIQ between the 2 cohorts differed by 16 points (95% confidence interval [CI]: [12][13][14][15][16][17][18][19][20] in favor of the term group, with 15% of adolescents born preterm scoring in the significantly impaired range (Ͻ70), compared with 2% of term controls. Among adolescents with NSI (n ϭ 50), some were either untestable or obtained the lowest possible score on all subtests of the WISC-III (n ϭ 2), the D-KEFS (n ϭ 15), or on all memory tasks (n ϭ 4).…”

Section: Resultsmentioning

confidence: 99%

“…Despite an attrition rate of 23% with the known selection bias that may result (ie, underestimation of impairment), 45 this rate is comparable to other long-term follow-up studies. 3,8,9,12 The study large sample size has allowed assessment of the impact of multiple relevant neonatal and demographic factors on outcomes.…”

Section: Discussionmentioning

confidence: 99%

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Executive and Memory Function in Adolescents Born Very Preterm

2011

PEDIATRICS

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WHAT'S KNOWN ON THIS SUBJECT:Very preterm children display significant school problems that persist into adolescence. Executive functioning and memory play important roles in learning and school attainment. WHAT THIS STUDY ADDS:This study confirms that adolescents born very preterm exhibit deficits in executive functioning and memory in a large contemporary sample. Severe brain injury and maternal education are strong predictors of performance on executive function and memory tasks. abstract BACKGROUND: Many preterm children display school difficulties, which may be mediated by impairment in executive function and memory. OBJECTIVE:To evaluate executive and memory function among adolescents born preterm compared with term controls at 16 years. METHODS:A total of 337 of 437 (77%) adolescents born in 1989 to 1992 with a birth weight Ͻ 1250 g and 102 term controls were assessed with a battery of executive function and memory tasks. Multiple regression analyses were used to compare groups and to identify associations between selected factors and outcomes among preterm subjects. RESULTS:Adolescents born preterm, compared with term controls, showed deficits in executive function in the order of 0.4 to 0.6 SD on tasks of verbal fluency, inhibition, cognitive flexibility, planning/organization, and working memory as well as verbal and visuospatial memory. After exclusion of adolescents with neurosensory disabilities and full-scale IQ Ͻ 70, significant group differences persisted on most tests. Preterm subjects, compared with term controls, were at increased risk of exhibiting problems related to executive dysfunction, as measured with the Behavior Rating Inventory of Executive Function, on the Metacognition Index (odds ratio [OR]: 2.5 [95% confidence interval (CI): 1.2-5.1]) and the Global Executive Composite (OR: 4.2 [95% CI: 1.6 -10.9]), but not on the Behavioral Regulation index (OR: 1.5 [95% CI: 0.7-3.5]). Among adolescents born preterm, severe brain injury on neonatal ultrasound and lower maternal education were the most consistent factors associated with poor outcomes. CONCLUSIONS:Even after exclusion of preterm subjects with significant disabilities, adolescents born preterm in the early 1990s were at increased risk of deficits in executive function and memory. Pediatrics 2011;127:e639-e646

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“…These characteristic postures can influence their motor development in the future [10][11][12] . In addition to these problems in structural and movement patterns, there are many studies that report preterm infants also have problems in looking at their hands, realizing their body image, developing cognition a n d s o c i a l i t y , a n d i n t e r a c t i n g w i t h t h e i r environment [13][14][15][16][17][18][19][20] . To support these preterm infants, a positioning program has been introduced to the NICU 21) .…”

Section: Introductionmentioning

confidence: 99%

The Influence of Positioning on Spontaneous Movements of Preterm Infants

et al. 2010

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Abstract. [Purpose] In this study, we quantitatively evaluated how the positioning program influenced the movement patterns of preterm infants in the neonatal intensive care unit (NICU). [Subjects and Methods] Spontaneous movements of 12 low-risk preterm infants were video-recorded at 38 or 39 postmenstrual weeks of age (PMA). Six of them (positioning group) received a positioning program from birth to 35-36 weeks of PMA while the other 6 (non-positioning group) did not. We attached reflective markers on the infant's wrists and ankles in the supine position and filmed them from above. By using a two-dimensional image analysis system, we digitized the wrist and ankle trajectories and analyzed the data by calculating several statistics.[Results] Infants in the positioning group brought their hands to the midline or crossed their hands over the midline and showed more variation in velocity of movements than those in the nonpositioning group. We also noticed that infants in the positioning group exhibited and maintained a movement pattern similar to that of full-term infants at 1 month after the positioning program was terminated.[Conclusions] These results suggest that appropriate positioning of preterm infants facilitates flexion posture and movement patterns toward the centre of the body similar to foetuses in the uterus.

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Motor and Cognitive Outcomes in Nondisabled Low-Birth-Weight Adolescents

Abstract: Specific prenatal, perinatal, and neonatal risk factors influence motor and cognitive performance in nondisabled LBW survivors well into adolescence, even when controlling for social risk. Advances in maternal-fetal and neonatal care can substantially improve these long-term outcomes.

Cited by 83 publications

References 44 publications

Score for Neonatal Acute Physiology–II and Neonatal Pain Predict Corticospinal Tract Development in Premature Newborns

Score for Neonatal Acute Physiology–II and Neonatal Pain Predict Corticospinal Tract Development in Premature Newborns

Executive and Memory Function in Adolescents Born Very Preterm

The Influence of Positioning on Spontaneous Movements of Preterm Infants

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