Infants born preterm are at high risk for the onset of cognitive dysfunctions at school age. The aim of this study was to investigate the association between early neurodevelopmental assessment and the risk of adverse cognitive outcome in extremely low birth weight children. We enrolled all newborns (January 2002 – April 2007) consecutively admitted to our Institution, with a birthweight < 1000 g. Exclusion criteria were genetic abnormalities, severe neurofunctional impairment, and/or neurosensory disabilities. Ninety-nine children were assessed at 1 year of corrected age using the Griffiths Mental Development Scales Revised. The same children were re-assessed at school age through the Wechsler Intelligence Scale for Children. Children with impaired Griffiths General Quotient (i.e., <1 SD) at 1 year of corrected age showed a significantly lower Full Scale Intelligence Quotient at 7 years of chronological age when compared to children who scored in the normal range at 1 year (p < 0.01). Considering the Griffiths Sub-quotients separately, a poor score in the Performance or in the Personal-Social Sub-quotients at 1 year was associated with significantly worse cognitive outcomes both in the Verbal and in the Performance Intelligence Quotients at 7 years (p < 0.01 and p < 0.05, respectively). A score <1 SD in the Locomotor or in the Eye and Hand Coordination Sub-quotients were specifically associated with poorer Performance or Verbal Intelligence Quotients, respectively (p < 0.05). Our findings suggest that a poor score on the Griffiths Scales at 1 year is associated with a higher risk of cognitive impairment at school age. Larger confirmation studies are needed.
At school age extremely low birth weight (ELBW) and extremely low gestational age (ELGAN) children are more likely to show Learning Disabilities (LDs) and difficulties in emotional regulation. The aim of this study was to investigate the incidence of LDs at school age and to detect neurodevelopmental indicators of risk for LDs at preschool ages in a cohort of ELBW/ELGAN children with broadly average intelligence. All consecutively newborns 2001–2006 admitted to the same Institution entered the study. Inclusion criteria were BW < 1000 g and/or GA < 28 weeks. Exclusion criteria were severe cerebral injuries, neurosensory disabilities, genetic abnormalities, and/or a Developmental Quotient below normal limits (< 1 SD) at 6 years. The presence of learning disabilities at school age was investigated through a parent-report questionnaire at children's age range 9–10 years. Neurodevelopmental profiles were assessed through the Griffiths Mental Development Scales at 1 and 2 years of corrected age and at 3, 4, 5, and 6 years of chronological age and were analyzed comparing two groups of children: those with LDs and those without. At school age 24 on 102 (23.5%) of our ELBW/ELGAN children met criteria for LDs in one or more areas, with 70.8% comorbidity with emotional/attention difficulties. Children with LDs scored significantly lower in the Griffiths Locomotor and Language subscales at 2 years of corrected age and in the Personal-social, Performance and Practical Reasoning subscales at 5 years of chronological age. Our findings suggest that, among the early developmental indicators of adverse school outcome, there is a poor motor experimentation, language delay, and personal-social immaturity. Cognitive rigidity and poor ability to manage practical situations also affect academic attainment. Timely detection of these early indicators of risk is crucial to assist the transition to school.
BackgroundThe availability of accurate assessment tools for the early detection of infants at risk for adverse neurodevelopmental outcomes is a major issue. The purpose of this study is to compare the outcomes of the Bayley Scales (Bayley-II vs Bayley-III) in a cohort of extremely low birth weight infants at 24 months corrected age, to define which edition shows the highest agreement with the Griffiths Mental Development Scales Revised.MethodsWe performed a single-centre cohort study. We prospectively enrolled infants with a birth weight of 401–1000 g and/or gestational age < 28 weeks. Exclusion criteria were the presence of neurosensory disabilities and/or genetic abnormalities. Infants underwent neurodevelopmental evaluation at 24 months corrected age using the Griffiths and either the Bayley-II (birth years 2003–2006) or the Bayley-III (birth years 2007–2010).ResultsA total of 194 infants were enrolled. Concordance was excellent between the Griffiths and the Bayley-III composite scores for both cognitive language and motor abilities (weighted K = 0.80 and 0.81, respectively) but poorer for the Bayley-II (weighted K = 0.63 and 0.50, respectively). The Youden’s Index revealed higher values for the Bayley-III than for the Bayley-II (75.9 vs 69.6 %). Compared with the Griffiths, the Bayley-III found 3 % fewer infants as being severely impaired in cognitive-language abilities and 7.8 % fewer infants as being mildly impaired in motor skills while the Bayley-II showed, compared with the Griffiths, higher rates of severely impaired children both for cognitive-language and motor abilities (14.1 and 15.3 % more infants respectively).DiscussionOur study suggests that the Bayley-III, although having a higher agreement with the Griffiths compared to the Bayley-II, slightly tends to underestimate neurodevelopmental impairment compared with the Griffiths, whereas the Bayley-II tends to overestimate it. ConclusionsOn the basis of these findings, we recommend the use of multiple measures to assess neurodevelopmental outcomes of extremely low birth weight infants at 24 months.
Background Recent literature has investigated the role of multiple birth on neurodevelopmental outcomes of premature infants, especially extremely preterm ones. Multiple gestations are often associated to increased neurodevelopmental disability. Actually, research findings are controversial. Objective To compare the neurodevelopmental and behavioral outcomes of multiples and singletons in a cohort of preterm infants ≤28 weeks gestational age at 1 and 2 years of corrected age. Methods The study included 86 infants, born from January 2014 to September 2017 and enrolled in the follow-up program provided at authors’ Institution. Exclusion criteria included: major brain lesions and malformations, severe neuro-sensorial deficits, genetic syndromes, single-twin survivors. Thirty four multiples were compared to 52 singletons, using the Griffiths Mental Development Scales and the Child Behavior Checklist 1½–5. Statistical analysis was based on ANOVA techniques to test group differences. A p < 0.05 was considered statistically significant. Results The neurodevelopmental outcomes of multiples and singletons at 1 and 2 years of corrected age did not significantly differ at a general level ( p > 0.05). Multiples showed significantly lower mean scores than singletons at 1 year in Locomotor (87.15 ± 11.94 vs. 92.48 ± 11.59) and Personal-Social (84.88 ± 10.25 vs. 89.63 ± 8.19) subscales. Considering the behavioral outcomes, higher rates of externalizing problems were observed in multiples at 2 years (54.27 ± 9.64 vs. 49.31 ± 10.39). Conclusion The slightly lower neurodevelopmental outcome showed by multiples, especially in the gross-motor and personal-social domains at 1 year, might be related to the specific environmental condition they experience. Multiple birth may affect mother’s sensitivity to infant’s needs and infant’s acquisition of emotional and behavioral regulation. This affects the separation process and the acquisition of the independent walking and other gross-motor skills. Being multiples might also induce an hyperstimulation and this could explain their higher vulnerability to externalizing problems (impulsiveness, hyperactivity, attention deficits). Additionally, males are more affected by the multiple condition than females.
Infants born preterm are at high risk of presenting neurodevelopmental delay. The Neurofunctional Assessment (NFA) describes infants’ neurodevelopment through the evaluation of six different domains. This study aimed to evaluate how, in a cohort of preterm infants, each NFA domain assessed at 3 months of corrected age (CA) was associated with neurodevelopment at 2 years of CA using the Griffiths Mental Developmental Scales Extended Revised (GMDS-ER). In addition, by introducing the NFA complexity score (CS), the study aimed to define a threshold that can help clinicians discriminate infants at higher risk of later neurodevelopmental delay. We conducted an observational, longitudinal study including 211 preterm infants. At 3 months of CA, infants who had normal scores in each domain showed a significantly higher GMDS-ER global quotient (GQ) at 2 years of CA. In addition, linear model results showed a significant negative relationship between the NFA CS and 2-year GMDS-ER GQ (estimate: − 0.27; 95% CI − 0.35, − 0.20; p value < 0.001). Each 10-point increase in the NFA CS was associated with an average 2.7-point decrease in the GMDS GQ. These results highlight how the NFA domains and NFA CS are compelling instruments for the early identification of children at risk for long-term adverse outcomes.
The goal of this study was to examine the effects of preterm birth and maternal childbirth‐related posttraumatic stress and parenting stress on maternal mind‐mindedness (MM). The study also investigated the effects of perceived social support on parenting stress and MM. Sixty‐five preterm (N = 32) and full‐term (N = 33) mother–infant dyads were observed at 6 months. Measures of maternal MM were obtained from observations of mother–infant interaction. Mothers also provided ratings of their posttraumatic stress disorder (PTSD) symptoms, parenting stress, and perceived social support via an online survey. Experiencing a preterm birth did not affect mothers’ use of mental state descriptors during mother–infant interaction. Neither childbirth‐related posttraumatic stress nor parenting stress directly affected maternal ability to comment on the child's mental states appropriately. However, at medium and high levels of perceived social support, a negative association between parenting stress and MM was observed. Maternal perception of being emotionally supported by significant others promoted MM in mothers showing low or mild levels of parenting stress, but not in mothers experiencing high stress in parenting their infants. Results suggest that a proclivity to MM might be affected by the interaction between parenting stress and social support, rather than by childbirth‐related variables, such as prematurity.
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