Prediction of Neurodevelopmental and Sensory Outcome at 5 Years in Norwegian Children Born Extremely Preterm

Leversen, Katrine Tyborg; Sommerfelt, Kristian; Rønnestad, Arild; Kaaresen, Per Ivar; Farstad, T; Skranes, J; Støen, Ragnhild; Elgen, Irene Bircow; Rettedal, Siren; Eide, Geir Egil; Irgens, Lorentz M.; Markestad, Trond

doi:10.1542/peds.2010-1001

Cited by 105 publications

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“…Our sample of EPT/ELBW children was extracted from a larger cohort that had lower intelligent quotient scores at 5 y than expected for children born at term (6). The children in the preterm group displayed slightly longer RTs than the control children, but not enough to obtain a significant difference.…”

Section: Fmri In Preterm Childrenmentioning

confidence: 99%

“…been invited at 2 and 5 y of age for medical and neurodevelopmental examinations (6). Two subjects could not be traced, one was excluded due to extensive neurological disabilities, and one was excluded due to dental braces that caused artifacts in the EPI images.…”

Section: Participantsmentioning

confidence: 99%

“…Even apparently well-functioning EPT children within the normal range of cognitive function often experience learning difficulties and are less likely to complete higher education than their term peers (2,3). Recent studies indicate that several preterm children suffer from attention, concentration, and learning difficulties (4)(5)(6)(7). Impairment of cognitive functions such as working memory and selective attention has been confirmed in preterm children by several authors (8)(9)(10).…”

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confidence: 95%

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fMRI: blood oxygen level–dependent activation during a working memory–selective attention task in children born extremely preterm

et al. 2013

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Section: Fmri In Preterm Childrenmentioning

confidence: 99%

Section: Participantsmentioning

confidence: 99%

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fMRI: blood oxygen level–dependent activation during a working memory–selective attention task in children born extremely preterm

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“…Many studies report that, the more prematurely a child is born, the higher the risk of neurodevelopmental impairment (Hintz, Kendrick, Vohr, et al, 2005;Leversen et al, 2011;Washburn et al, 2007;Wilson-Costello, Friedman, Minich, Fanaroff, & Hack, 2005). It is a matter of debate whether or not the improvements in survival among extremely preterm infants have also increased the risk of neurodevelopmental impairment among survivors.…”

Section: Introductionmentioning

confidence: 99%

Longitudinal Studies of Executive and Cognitive Development After Preterm Birth

Lundequist¹

2012

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The population of survivors after preterm birth is increasing, and, in conjunction with this, there is growing concern about their long-term development. Stockholm Neonatal Project (SNP) is a longitudinal population-based study of children born prematurely in 1988-93, with a very low birth weight (<1500 g), who have been followed prospectively from birth through adolescence. A matched control group was recruited at age 5 ½ years. The overall aim of this thesis was to investigate the long-term development of preterm children compared to controls, paying particular attention to their executive functions (EF) in relation to the degree of prematurity, birth weight and medical risks. Study I, utilizing Bender drawings and other data obtained at age 5 ½ years, showed a disadvantage in visuo-motor development in preterm children, especially among the boys. Visuo-motor skills were highly related to performance IQ (PIQ) in both groups, and also to EF in the preterm group. In Study II, data from the NEPSY test battery administered at age 5 ½ was used, and neuropsychological profiles typical of preterm children and term born children respectively, were identified through cluster analysis. The general level of performance corresponded well with intelligence, motor functions and parental education in both groups, but preterm children had overall lower results and exhibited greater variability across domains. Study III showed that extremely preterm birth (w. 23-27) per se poses a risk for cognitive outcome at age 18, particularly for EF, and that perinatal medical complications add to the risk. By contrast, adolescents born very preterm (w. 28-31) performed just as well as term-born controls in all cognitive domains. However, adolescents who had been born moderately preterm (w. 32-36) and small for gestational age, showed general cognitive deficits. Study IV found that cognitive development was highly stable over time, with parental education and EF at 5 ½ years being significant predictors for cognitive outcome at age 18, in both groups. In the preterm group, perinatal medical risks and being small for gestational age continued to significantly influence development from 5 ½ to 18 years. Study V demonstrated that neuropsychological scoring of Bender drawings, which was developed in study I, predicted general cognitive outcome as well as EF in adolescence. This indicates that developmental screening using Bender drawings with neuropsychological scoring may be useful around school entry.In summary, the results illustrate that cognitive outcome after preterm birth is highly diverse and influenced by biological and environmental factors. No single factor can explain or predict children's development, but we conclude that extreme prematurity presents a particular risk for EF dysfunction. Developmental screening is recommended to identify children who may benefit from special educational interventions.

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“…Forskningen er omfattende, men jeg vil i hovedsak vise til erfaringene fra en fersk metaanalyse fra Nasjonalt kunnskapssenter for helsetjenesten 10 , den norske studien Prosjekt Ekstrem Prematuritet (PEP) som omfatter alle barn født før 28 svangerskapsuker eller med en fødselsvekt under 1000 gram i Norge i 1999 og 2000 11,12 , den svenske EXPRESS-studien som omfatter alle barn med svangerskapsalder under 27 uker født i Sverige i [2004][2005][2006][2007] 6,7 , og de to engelske EPICurestudiene som omfatter alle barn med svangerskapsalder under 26 uker i Storbritannia i 1995 (EPICure 1) og 2006 (EPICure2) 13,14 .…”

Section: Forskningsbasert Kunnskapunclassified

Det ekstremt for tidlig fødte barnet; hvordan går det?

Markestad¹

2017

Nor J Epidemiol

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This is an open access article distributed under the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Sønn av president John F. Kennedy og kona Jacqueline, Patrick, ble født 5 ½ uke for tidlig i 1963 og veide 2110 gram. Han døde etter 2 døgn av neonatalt ånde-nødssyndrom (respiratory distress syndom -RDS) som skyldes mangel på surfaktant. Det var det vanlige utfallet av betydelig prematuritet den gangen. Patricks død ga støtet til økt forskning i nyfødtmedisin. I 1964 viste Paul R. Swyer i Toronto at for tidlig fødte barn med umodne lunger kunne overleve med respiratorbehandling 1 , og respiratorbehandling ble snart rutine. De neste store fremskrittene var å gi glukokortikoid til mor før fødsel for å fremme fosterets surfaktantsyntese 2 (rutine fra ca. 1980) og å sprøyte farmasøytisk fremstilt surfaktant ned i lungene (fra begynnelsen av 1990-tallet) 3 . Sammen med bedre teknologi for assistert ventilasjon og overvåkning av vitale funksjoner, samt økt kunnskap og kompetanse, har dette ført til at få av barna dør av lungesykdom i dag.Selv om risikoen for død og alvorlige funksjonsnedsettelser øker med grad av prematuritet 4 , er det i dag størst bekymring knyttet til fremtidig helse og funksjonsnivå hos barn som overlever ekstrem prematuritet, dvs. fødsel før 28 ukers svangerskap. Det gjelder ca. 0,5% av alle fødsler i Norge, ca. 300 barn per år 5 . I dag er det mulig å redde noen barn som fødes i uke 22, men hva som bør vaere en nedre grense for å tilby livreddende behandling, diskuteres kontinuerlig. I Sverige er det blitt vanlig å behandle fra 22 svangerskapsuker 6,7 mens Frankrike i praksis ikke gir livreddende behandling ved 23 uker og i langt mindre grad enn hos oss ved 24 uker 8 . I Norge diskuteres det om det er etisk akseptabelt å avstå fra å gi livreddende behandling ved fødsel før 24 svangerskapsuker, og om hvilke skader og sykdom som kan vaere grunnlag for å avslutte livsforlengende behandling 9 . En fersk spørre-undersøkelse viser at alle føde-og barneavdelingene i Norge i praksis gir livreddende behandling ved fødsel i uke 24 uten vanligvis å gå inn på en diskusjon om dette med foreldrene, og også i uke 23 dersom foreldrene ønsker eller aksepterer det 10 . Noen få barn har de siste årene også overlevd etter fødsel i uke 22.Nyfødtmedisinen må nok alltid leve i en gråsone for når det er rimelig å tilby livreddende behandling og for hva foreldrene skal kunne kreve, både med hensyn til å avstå fra og forlange aktiv behandling. Forskningsbasert kunnskap om prognose med tanke på overlevelse og risiko for funksjonsnedsettelser, belastning for barnet og familien og kostnad for samfunnet, er grunnleggende for en fruktbar diskusjon om grenser for å starte livreddende behandling, sammen med vekting av etiske prinsipper om retten til liv.

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Prediction of Neurodevelopmental and Sensory Outcome at 5 Years in Norwegian Children Born Extremely Preterm

Abstract: The outcome was poorer for children with gestational ages of 25 weeks or less compared with those with gestational ages between 26 and 27 weeks. For those without cerebral palsy, blindness, or deafness, however, gestational age had a limited association with cognitive and motor function.

Cited by 105 publications

References 56 publications

fMRI: blood oxygen level–dependent activation during a working memory–selective attention task in children born extremely preterm

fMRI: blood oxygen level–dependent activation during a working memory–selective attention task in children born extremely preterm

Longitudinal Studies of Executive and Cognitive Development After Preterm Birth

Det ekstremt for tidlig fødte barnet; hvordan går det?

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