One hundred and thirty-seven very low birthweight (VLBW) children were compared at 12 years with a sample of matched peers on a number of psychiatric symptoms including Attention Deficit/Hyperactivity Disorder, depression, anxiety, and antisocial behaviour using the Child and Adolescent Psychiatric Assessment parent interview and various parent and child questionnaires. The main psychiatric risk was Attention Deficit Hyperactivity (ADH) disorders, with 31/136 (23%) VLBW children meeting clinical criteria, compared to 9/148 (6%) of peers. VLBW children were also more likely to have generalised anxiety and more symptoms of depression. More than one quarter of VLBW children (38/136; 28%) showed a psychiatric disorder of some type compared to 9% (14/148) of peers. VLBW children are at increased risk of psychiatric symptoms especially ADHD. This outcome is discussed in relation to neurological, demographic, and cumulative impairment factors.

Torrespondetice tofirst aictbor lit Kesearch Associate, Centre for Educational Needs, School of Educatih, University o f Manchcster, Oxford Hoad. MI3 91'1.. A cohort of 138 very-low-birthweight (VLBW) 12-year-old children and matched control children were assessed on objective cognitive and educational measures. School performance was rated by teachers and by the children themselves. VLBW children were shown to have lower IQ scores, and poorer scores on all objective educational measures compared with control children. Controlling for IQ * .

Aim-To determine whether poor motor skills, previously identified in a cohort of very low birthweight (<1250 g) children, born in 1980-1, have persisted or improved. Previous assessments had shown significant improvement between the ages of 6 and 8 years. Methods-The original cohort were traced and were assessed using the Movement Assessment Battery for Children, an update of the Test Of Motor Impairment, used at 6 and 8 years. Where possible the classroom-matched controls from the original studies were assessed, otherwise new controls were selected. Teachers were also asked to identify those children whom they considered clumsy. Forty seven of the original cohort of 53 children, all but one still attending mainstream school, and 40 original and 20 new classroom-matched controls were studied. Results-Fifty one per cent of the cohort showed clinically important or borderline impairment. More of these children had significant impairment (16/47, 34%) than the controls (3/60, 5%). The improvement seen by 8 years of age was maintained but there was no further improvement. Girls had significantly higher overall impairment scores (median 16; interquartile range 10-21.5) than the boys (5.5 (15-12-5)), and on a wider variety of subtests (5/8) than the boys (3/8). Conclusions-Many very low birthweight children have impaired motor skills. Despite early improvement it persists into adolescence and the deficit remains. Interventional studies may help to see if these problems can be alleviated. (Arch Dis Child 1995; 73: F62-F66)

Aims-To compare the growth of very low birthweight (VLBW) children in early adolescence with that of their normal birthweight peers; to examine the role of factors contributing to growth-parental height, perinatal variables, bone maturity and sexual maturation; to examine the correlation between head growth and cognitive and educational outcome. Methods-Standing and sitting heights, weight, occipito-frontal circumference (OFC), skinfold thicknesses and pubertal staging were assessed in 137 VLBW children and 160 controls at 11-13.5 years of age. Ninety six (70%) of the VLBW children had their bone age assessed using the TW2 method. Reported parental heights were obtained by questionnaire.

Aims-To compare the visual function of a cohort of very low birthweight (VLBW) children in early adolescence with that of their normal birthweight peers; to correlate visual impairment in this group with available perinatal data; and to examine the relation between the visual ability of VLBW children and their cognitive and motor skills. Methods-As part of a long term neurodevelopmental study, 137 VLBW children and 163 normal birthweight controls were visually assessed between the ages of 11 and 13 years. Their eyes were examined for strabismus and movement disorders, and the use of visual correction for refractive errors was noted. Measures were made of visual acuity, stereopsis, and contrast sensitivity. All children had standardised tests of motor ability and cognitive skills. Perinatal data, including cranial ultrasonography results, had been obtained from the children's notes. No data were available however, regarding retinopathy of prematurity as screening was not established when these infants were born. Results-On all measures, the visual function of the VLBW children was poorer than that of the controls. Reduced visual function was present in 63.5% of VLBW children compared with 36% of controls. Poor contrast sensitivity and strabismus were predictive of poor motor skills in the VLBW children. Poor contrast sensitivity and poor visual acuity (at 0.3 metres) were predictive of lower IQ. Low birthweight, intraventricular haemorrhage, intrauterine growth retardation and low 1 minute Apgar scores predicted reduced visual function. Conclusions-VLBW children have a high incidence of impaired vision. Stereopsis and contrast sensitivity are useful additions to the screening of this high risk group. They identified impaired vision that was not detected by normal screening and were related to impaired neurodevelopmental outcome. (Arch Dis Child 1997;76:F82-F87)

SUMMARY The authors assessed 137 VLBW children and 162 controls for laterality by observation and questionnaire at 12 years of age. A significantly higher proportion of the VLBW children were either left‐handed or mixed‐handed. A number of motor, cognitive and educational outcome variables were measured. Impaired manual dexterity was found to be significantly more common in VLBW non‐right‐handers. This group was also found to be more at risk of poor near vision. No cognitive or educational outcomes were associated with handedness. The results seem to support the theory that at least in a proportion of VLBW children, non‐right‐handedness has a pathological basis, but the relationship to perinatal events remains obscure. RÉSUMÉ Prédominance mamtelle à 12 ans chez l?s enfonts de très foible poids de noissatwe (VLBW): sa relation avec les variables périnatales et de devenir. Les auteurs ont évalué la prédominance manuelle chez 137 enfants VLBW et 162 contrôles par ľobservation et un questionnaire, àľàge de 12 ans. Un nombre significativement plus élevé ďenfants VLBW étaient gauchers ou ambidextres. Plusieurs variables du devenir concernant la motricité, les fonctions cognitives et pédagogiques furent mesurées. Un défaut de dextérité manuelle fut trouvé plus fréquemment de façon significative chez les enfants VLBW non droitiers. Ce groupe fut trouvéégalement à plus grand risque de troubles de la vision de près. Aucun devenir cognitif ou Sducatif n'était associé a la prédominance manuelle. Les résultats semblent favoriser ľhypothèse selon laquelle, au moins une part de la prédominance non droitière chez les enfants VLBW a une signification pathologique mais la relation avec ľanamnèse périnatale demeure obscure. ZUSAMMENFASSUNG Handdominanz bei Kindern mit sehr niedrigem Geburtsgewicht (VLBW) im Alter von 12 Jahren: Relation zu Variablen der Perinatalperiode und des Outcomes Durch Beobachtung und mit Hilfe cines Fragebogens untersuchten die Autoren 137 VLBW Kinder und 162 Kontrollen im Alter von 12 Jahren im Hinblick auf ihre Handdominanz. Eine signifikant höhere Anzahl von VLBW Kindern war entweder linkshändig oder beidhändig. Zur Beurteilung des Outcomes wurden verschiedene motorische, cognitive und die Ausbildung betreffende Parameter untersucht. Die nicht rechtshändigen Kinder waren signifikant häufiger manuell ungeschickt. Außcrdcm fand sich in dieser Gruppe ein größeres Risiko für Sehstörungen im Nahbereich. Cognitive und schulische Outcome Parameter waren von der Händigkeit unabhängig. Die Befunde scheinen für die Theorie zu sprechen, daß wenigstens bei einem Teil der VLBW Kinder die nicht Rechtshändigkeit eine pathologische Ursache hat, aber der Zusammenhang mit perinatalen Ereignissen bleibt unklar. RESUMEN Predominio manual en niños de mux bajo peso al nacer (VLBW) a los dos años de edad; su relación con variables perinatales y de curso Los autores evaluaron 137 niños VLBW y 162 controles investigando su lateralidad, por observaciön y cuestionario, a los 12 años dc edad. Se observö una proporciön significativa...

A reduction in neonatal respiratory morbidity can be achieved by delaying elective caesarean section until 39 weeks gestation.

The nasal-tragus length predictor improved the accuracy of endotracheal tube positioning after oral intubation. It is a simple, fast, reproducible method and can be used in everyday practice to help avoid significant endotracheal tube malposition.