Behavior at 10 and 13 years of age for children with low birth weight

This study was based on data from a longitudinal research program. The cohort consisted of 874 normal children in an entire school grade in a Swedish community. The aim of the study was to investigate the relation between birth weight and behavior at school, for all children and for each sex separately. The results identified specific aspects of behaviour disorder significantly related to low birth weight (LBW) for children at the age of 10 but not at the age of 13. When the sexes were separated, there were no relations between birth weight and deviant behaviour for boys of low birth weight as compared to boys of normal birth weight, while girls of low birth weight showed specific behavioural disorders at age 10 as compared to girls of normal birth weight. For girls reared in families of low parental socioeconomic status, aggressiveness and motor restlessness at age 10 but not at age 13 was also present. Further analyses showed that girls born small-for-gestational age showed lack of school motivation and concentration difficulties both at age 10 and age 13.     

Maternal attachment representations and the development of very low birth weight premature infants at two years of age

There is a consensus that prematurity could increase the risk of attachment impairment. We studied 90 premature children with very low birth weights (<1,500 g) and 96 healthy children born at term with similar age and sociodemographic characteristics. Our objective was to assess maternal stress and attachment representations, and compare development indices on both groups at 2 years of age. Premature infants had a medium‐to‐severe degree of immaturity and biological risk (M gestational age = 29.98 weeks; birth weight = 1,159.76 g), with 57% staying in the ICU ≥1 week. These children born prematurely had lower scores on the development indices within the normal range. Mothers of premature infants (n = 74) reported higher levels of stress during their first year of life (59%) than did controls (41%), but no significant differences were detected in maternal attachment discourse between the two groups. The findings confirm that premature birth has a great influence on maternal emotional responses and the health and development of children in the first years of life, and indicate that stress responses in parents and warning signs for attachment problems should be assessed as early as possible.     

Sources of variability in sequelae of very low birth weight.

Few investigations have examined the specificity of sequelae of very low birth weight (VLBW, <1500 g) or sources of variability in outcome. To better understand the nature and determinants of outcome, we assessed neuropsychological and achievement skills at mean age 11 years in 62 children with <750 g birth weight, 54 with 750-1499 g birth weight, and 66 term-born controls. Distinct cognitive constructs were identified by factor analysis, and the three birthweight groups were compared on these constructs and on composite measures of achievement. Although the group with <750 g birth weight performed less well on all tests than term-born controls, group differences in a perceptual planning factor and in mathematics remained even when IQ was controlled, and deficits were more pronounced in mathematics than in reading. Results from structural equation modeling were consistent with the hypothesis that neuropsychological skills mediated the relationship between birth weight and achievement. The findings confirm the differential deficit hypothesis, support the need to consider multiple sources of variability in VLBW outcomes, and highlight the importance of neuropsychological constructs in developing an explanatory framework.     

Visual configural processing in adults born at extremely low birth weight

Being born at extremely low birth weight (ELBW; ≤1,000 g) is associated with enduring visual impairments. We tested for long‐term, higher order visual processing problems in the oldest known prospectively followed cohort of ELBW survivors. Configural processing (spacing among features of an object) was examined in 62 adults born at ELBW (M_age = 31.9 years) and 82 adults born at normal birth weight (NBW; ≥2,500 g: M_age = 32.5 years). Pairs of human faces, monkey faces, or houses were presented in a delayed match‐to‐sample task, where non‐matching stimuli differed only in the spacing of their features. Discrimination accuracy for each stimulus type was compared between birth weight groups, adjusting for neurosensory impairment, visual acuity, binocular fusion ability, IQ, and sex. Both groups were better able to discriminate human faces than monkey faces (p < .001). However, the ELBW group discriminated between human faces (p < .001), between monkey faces (p < .001), and to some degree, between houses (p < .06), more poorly than NBW control participants, suggesting a general deficit in perceptual processing. Human face discrimination was related to performance IQ (PIQ) across groups, but especially among ELBW survivors. Coding (a PIQ subtest) also predicted human face discrimination in ELBW survivors, consistent with previously reported links between visuo‐perceptive difficulties and regional slowing of cortical activity in individuals born preterm. Correlations with Coding suggested ELBW survivors may have used a feature‐matching approach to processing human faces. Future studies could examine brain‐based anatomical and functional evidence for altered face processing, as well as the social and memory consequences of face‐processing deficits in ELBW survivors.     

Selective deficit in spatial location memory in extremely low birth weight children at age six: The PETIT Study

Spatial location memory has rarely been assessed in young children due to a scarcity of developmentally appropriate tests. This study sought to compare nonverbal learning and recall in children born extremely low birth weight (ELBW; <1000 g) and less than 33 gestational weeks (GW) with term-born children at early school age using a recently developed and adapted test. We administered a modification of the Hopkins Board to 210 children at age six; 84 born ELBW (35 born < 26 GW; 49 born 26–33 GW) and 126 term-born. Six measures were obtained: naming, trials-to-criterion, errors-to-criterion, delayed item recall, delayed location recall, and percent retention. After age correction, ELBW children had worse general cognition, item naming, delayed item recall, delayed location recall, and percent retention than term-born children. Delayed item recall and percent retention performances of ELBW children remained worse after correction for general cognition. ELBW groups (< 26 GW and 26–33 GW) groups performed worse than term-born children in naming and delayed item recall with chronological age as covariate. Those born before 26 GW, but not 26–33 GW, performed worse than term-born children in delayed location recall and percent retention. Differences remained significant after controlling for gender, maternal education, and delivery type. All three groups' performance declined from final learning trial to delayed location recall, with a decline greater for less than 26 GW than term-born children. Extreme prematurity (< 26 GW) and ELBW are significant risk factors for spatial location memory deficit. The modified Hopkins Board discriminated high-risk preterm and term-born children at early school age and appears to be a useful test to measure this rarely studied cognitive capacity.     

Test of visuospatial construction: Validity evidence in extremely low birth weight and late preterm children at early school age

The Test of Visuospatial Construction (TVSC), a measure of visuoconstruction that does not rely on upper extremity motor response or written production, was administered to extremely low birth weight (ELBW), late preterm (LPT), and term participants at preschool (n = 355) and kindergarten (n = 265) ages. TVSC showed statistically significant weak-to-moderate positive correlations (age 3: r = .118–.303; age 6: r = .138–.348) with Developmental VMI, Differential Ability Scales-II Copying, Matrices, and Pattern Construction subtests, Baron-Hopkins Board Test, and the Purdue Pegboard. One-way ANOVA indicated ELBW performed worse than Term (p = .044) on visuospatial construction at age 3 with a small-to-medium effect size (d = ?0.43). No other statistically significant differences were found at age 3 on the TVSC (ELBW/LPT: p = .608, d = ?0.17; LPT/Term: p = .116, d = ?0.31). At age 6, ELBW participants performed worse than LPT participants (p = .027) and Term participants (p = .012); LPT participants did not differ from Term participants. Small effect sizes at age 3 (ELBW < LPT, d = ?0.17; ELBW < Term, d = ?0.43) were notably larger at age 6 (ELBW < LPT, d = ?0.42; ELBW < Term, d = ?0.53). Important practical differences showing LPT participants performed below Term participants (d = ?0.31) at age 3 were no longer evident at age 6 (d = ?0.097). These findings provide preliminary evidence of TVSC validity supporting its use to detect neuropsychological impairment and to recommend appropriate interventions in young preterm children.     

School performance and IQ-test scores at age 13 as related to birth weight and gestational age

The cohort in the present longitudinal research program consisted of 873 children in an entire school grade, in a Swedish community. The present results showed a main effect of birth weight; low birth weight (LBW) children had lower school performance and intelligence-test (IQ) scores at age 13 than did normal birth weight (NBW) children irrespective of parental SES. Second, there was no significant main effect of gestational age (GA) on scholastic performance and IQ-test scores. Third, there was a significant main effect of the combination of birth weight and GA on scholastic performance and IQ-test scores. The LBW children born at term (38-40 pregnancy weeks; pw) had significantly lower scores and school grades as compared to the control group while the LBW children born with short gestational age (34-37 pw) and with very short gestational age (less than 34 pw) had significantly lower scores and marks in fewer areas of academic attainment.     

Measuring functional outcomes after prematurity: developmental impact of very low birth weight and extremely low birth weight status on childhood disability

Our purpose was to describe functional outcomes in essential activities in preschool, school-age, and adolescent children who were born very (<32 weeks gestation) and extremely (<28 weeks gestation) prematurely. Very low birth weight (VLBW; 1000-1499 g), or extremely low birth weight (ELBW;<1000 g) populations are the focus of our analysis. We describe models of disablement and enablement for specifying the complexity of childhood outcomes using a framework of pathophysiology, impairment, functional limitation and functional strengths, disability in social roles and social participation, societal limitations and environmental facilitators. Representative early childhood, preschool, school-age, and adolescent studies were examined in terms of describing children's functional strengths and challenges after VLBW and ELBW survival. In early childhood, disability was assessed by diagnosing neurosensory impairments and delays on developmental testing. Instruments for measuring functional status in essential activities of self-care, mobility, communication and learning are described. Rates of neurosensory disability in the first three years among recent ELBW survivors ranged from 9-26% for cerebral palsy, 1-15% for blindness, 0-9% for deafness, and 6-42% for evolving cognitive disability (MDI <70). Rates of preschool functional limitation were 5-27% motor, 5-30% self-care, and 5-22% communicative. Rates of school-age functional educational disabilities exceeded 50%. Rates of adolescent activity limitation were 13-32% and vocational limitations were 27-71%. By examining the functional strengths and challenges of children with major neurodevelopmental impairments after very or extremely preterm birth, we can examine causal pathways that lessen the risk of severe functional disability. Among children with mild to moderate disability, we can enhance functional outcomes, optimize community participation, and provide quality family supports. In order to assess the changing outcomes of this vulnerable population of survivors, combinations of clinical and survey based methodologies are required.     

Local and global aspects of biological motion perception in children born at very low birth weight

Biological motion perception can be assessed using a variety of tasks. In the present study, 8- to 11-year-old children born prematurely at very low birth weight (<1500 g) and matched, full-term controls completed tasks that required the extraction of local motion cues, the ability to perceptually group these cues to extract information about body structure, and the ability to carry out higher order processes required for action recognition and person identification. Preterm children exhibited difficulties in all 4 aspects of biological motion perception. However, intercorrelations between test scores were weak in both full-term and preterm children—a finding that supports the view that these processes are relatively independent. Preterm children also displayed more autistic-like traits than full-term peers. In preterm (but not full-term) children, these traits were negatively correlated with performance in the task requiring structure-from-motion processing, r(30) = ?.36, p < .05), but positively correlated with the ability to extract identity, r(30) = .45, p < .05). These findings extend previous reports of vulnerability in systems involved in processing dynamic cues in preterm children and suggest that a core deficit in social perception/cognition may contribute to the development of the social and behavioral difficulties even in members of this population who are functioning within the normal range intellectually. The results could inform the development of screening, diagnostic, and intervention tools.     

Psychological problems and associated factors at 6 years of age: differences between sexes

In a non-clinical group of 130 children (65 boys and 65 girls), we evaluated the relationships between psychological problems using the Child Behavior Checklist (CBCL) reported by parents, the Inattention Overactivity With Aggression (IOWA) scale reported by teachers, individual factors (Intellectual quotient [IQ], temperament and heart rate) and environmental factors (stress events, mother's profession and being or not being an only child). We found no differences between the sexes in the prevalence of total psychological problems in the clinical range, but girls had significantly more borderline total problems than boys. Girls tended to have more externalizing problems than boys. In boys, there were more links between individual and environmental factors and psychological problems, especially externalizing problems. A high score in psychological problems assessed by the CBCL affected the school performance of boys and the social performance of girls. For boys, IQ was significantly lower when the score for total behavioral problems was higher, and for girls IQ was significantly lower when the score for externalizing problems was higher. Understanding the different levels of vulnerability of the sexes at different periods of development may help to improve the treatment children in this age group receive.     

Preterm birth affects dorsal-stream functioning even after age 6

With increasing numbers of preterm infants surviving, the impact of preterm birth on later cognitive development presents a major interest. This study investigates the impact of preterm birth on later dorsal- and ventral-stream functioning. An atypical pattern of performance was found for preterm children relative to full-term controls, but in the dorsal-drawing task only. These findings suggest that the number of gestational weeks does affect dorsal-stream functioning, even after more than 6 years of favorable environmental conditions in healthy preterm children.     

Developmental change in the neuropsychological functioning of very low birth weight infants

Research on very low birth weight (VLBW) infants has not carefully evaluated developmental patterns of neurological and neuropsychological functioning across time. This study reports on a broad range of developmental outcomes for VLBW infants of low (LR, n = 116) and high (HR, n = 84) medical risk compared to full term infants (FT, n = 120) across 6, 12, and 24 months of age. While low risk infants showed initial delays in most areas, faster rates of change in motor and neurological development resulted in catch-up by 2 years of age as compared to the FT infants. The lack of acceleration in development of mental skills demonstrates a persistent lag in this area. In contrast, HR infants showed initial delays in all areas as compared to both LR and FT infants with slower rates of change in mental and expressive language skills. Although faster rates of change were evident for HR infants in motor, neurological, and receptive language skills, scores in these areas remain lower than those for the LR and FT infants. The absence of accelerated rates of development for certain VLBW infants has implications for prognosis and patient access to early intervention services.     

Neurodevelopmental impairment: Predictors of its impact on the families of extremely low birth weight infants at 18 months

Effects on a family of a child with chronic illness have been described. The Impact on Family Scale (IOF) was developed to measure these effects. The impact of extremely low birth weight (ELBW) infants with neurodevelopmental impairment on families is unknown. This study determined IOF scores for families of ELBW infants with increasing degree of impairment at 18 months and identified factors that increase vulnerability to impact. A total of 3,849 ELBW infant survivors born at the 16 centers of the National Institute of Child Health and Human Development Neonatal Research Network between January 1993 and February 2001 were assessed at 18 to 22 months. Infants were divided into four groups by degree of impairment. IOF scores were analyzed by impairment group. Multivariate analyses assessed effects of impairment, social/demographic factors, unmet service needs, and resource utilization on the IOF. A total of 1,624 (42.2%) infants had moderate/severe impairment. Increasing severity of impairment was associated with higher IOF scores. Severity of impairment contributed 6% of variance to the IOF scores. Twenty‐one percent of variance was contributed by additional medical needs, low socioeconomic status (SES), and lack of social support. Although increasing severity of impairment impacts families of ELBW infants, significantly more impact is contributed by additional medical needs, low SES, and lack of social support.     

Maternal pregnancy-specific anxiety is associated with child executive function at 6-9 years age

Because fetal brain development proceeds at an extremely rapid pace, early life experiences have the potential to alter the trajectory of neurodevelopment, which may increase susceptibility for developmental and neuropsychiatric disorders. There is evidence that prenatal maternal stress and anxiety, especially worries specifically related to being pregnant, influence neurodevelopmental outcomes. In the current prospective longitudinal study, we included 89 women for whom serial data were available for pregnancy-specific anxiety, state anxiety, and depression at 15, 19, 25, 31, and 37 weeks gestation. When the offspring from the target pregnancy were between 6 and 9 years of age, their executive function was assessed. High levels of mean maternal pregnancy-specific anxiety over the course of gestation were associated with lower inhibitory control in girls only and lower visuospatial working memory performance in boys and girls. Higher-state anxiety and depression also were associated with lower visuospatial working memory performance. However, neither state anxiety nor depression explained any additional variance after accounting for pregnancy-specific anxiety. The findings contribute to the literature supporting an association between pregnancy-specific anxiety and cognitive development and extend our knowledge about the persistence of this effect until middle childhood.     

Parenting of low birth weight infants: A review of issues and interventions

Factors that may adversely affect parenting of low birth weight infants, including infant characteristics, parental emotional responses to premature birth, and patterns of parent-infant interaction, are reviewed. In addition, intervention studies designed to improve infant developmental outcomes through influencing parenting behaviors are examined. There was great diversity in theoretical frameworks, in timing of onset and frequency of interventions, and in measurement of outcomes. The interventions that were most effective in influencing behaviors and infant developmental outcomes were those in which there were multiple long-term contacts with parents and/or those that actively involved them in the intervention. The specific theoretical framework upon which the interventions were based appeared to be of less importance in influencing results. In order to increase our knowledge and ability to provide costeffective programs, there is a need to focus attention and data collection efforts on the process and intermediary steps of intervention as well as on outcome measures. There is also a need to improve our ability to recruit and retain those families who are most at risk for parenting and infant developmental problems including those with very low birth weight infants, those whose infants have serious perinatal complications, and those with indications of high social risk such as poverty-level incomes and problems of substance abuse.     

Assessment of parental sensitivity towards pre-school children born with very low birth weight

The article introduces the Parental Sensitivity Assessment Scale (PSAS) and examines the influence of the PSAS score and other factors on the general cognitive level in pre-school children born with very low birth weight (VLBW). McCarthy general cognitive index (GCI) was obtained for 102 VLBW and 92 normal birth weight (NBW) control children in Denmark in the mid-1980s. The mean ages of the two groups were 52.4 vs. 53.1 months. Parental sensitivity was assessed using PSAS. There was no significant difference in the mean PSAS score between the two birth weight groups (p > 0.3). Birth weight group (p < 0.001) and mother's schooling (p= 0.026) significantly correlated with GCI in the children. The PSAS score was highly significantly correlated to the variance of the GCI (p < 0.001), which was not explained by VLBW and mother's schooling. We found no interactional effect between parental sensitivity and birth weight group (p > 0.5) - the prematurely born children were not more affected by low parental sensitivity than were the control children.     

Poverty,ethnicity, and risk of obesity among low birth weight infants

The independent and joint effects of family and neighborhood poverty and ethnicity upon weight trajectories from age two to six-and-a-half were examined using data from the Infant Health and Development Program (N = 985), an early intervention program for low birth weight children and families. At age two, family poverty was associated with higher body mass index (BMI), whereas neighborhood poverty and ethnicity were not. Over time, the BMI of toddlers from poor and near poor neighborhoods increased nonlinearly, while those from nonpoor neighborhoods remained stable. BMIs of Hispanic-American toddlers increased steadily over time, unlike African-American and Anglo-American toddlers. Although initially similar, over time African-American toddlers' BMIs increased more rapidly than Anglo-American toddlers. Family and neighborhood poverty and ethnicity were associated with BMI. More work is needed on how poverty and ethnicity contribute to differences in early weight gain in conjunction with sociocultural and environmental factors in the home and community.