Background and AimsThe Bayley Scales of Infant Development (BSID) is the most widely used measure to assess neurodevelopment of very preterm (gestational age ≤32 weeks) and very low birth weight (VLBW, ≤1500grams) infants in the first three years of life. This meta-analysis determines the predictive value of the mental subscale (MDI) and motor subscale (PDI) of the BSID for later (≥36 months) motor and cognitive development in very preterm/ VLBW children. Methods PubMed, PsychINFO and CINAHL were searched for English-language peer-reviewed studies published before April 2012. Studies were included if they reported odds ratios or correlations between the MDI/PDI scores obtained in the first three years of life, and standardized intelligence or motor assessment in childhood (≥36 months of age). Meta-analytic methods were applied to aggregate available data. Results A total of 16 studies met inclusion criteria. Across 15 studies encompassing 1335 very preterm/VLBW children, MDI scores were strongly predictive for later cognitive development, r=0.61 (95%CI: 0.57-0.64), p<0.001. The relationship between MDI scores and later cognitive development was not mediated by birth weight (p=0.56), gestational age (p=.70), and time interval between assessments (p=0.55). Across four studies including 465 very preterm/ VLBW children, PDI scores were moderately predictive for later motor function, r=0.32 (95%CI: 0.22-0.40), p<0.001. Conclusions In very preterm/VBLW children, MDI scores explain 37% of the variance in later cognitive functioning, whereas PDI scores explain 10% of later motor development. Thus a large proportion of the variance remains unexplained, underlining the importance of enhancing prediction of developmental outcomes.
Background and AimsThe Bayley Scales of Infant Development (BSID) is the most widely used measure to assess neurodevelopment of very preterm (gestational age ≤32 weeks) and very low birth weight (VLBW, ≤1500grams) infants in the first three years of life. This meta-analysis determines the predictive value of the mental subscale (MDI) and motor subscale (PDI) of the BSID for later (≥36 months) motor and cognitive development in very preterm/ VLBW children. Methods PubMed, PsychINFO and CINAHL were searched for English-language peer-reviewed studies published before April 2012. Studies were included if they reported odds ratios or correlations between the MDI/PDI scores obtained in the first three years of life, and standardized intelligence or motor assessment in childhood (≥36 months of age). Meta-analytic methods were applied to aggregate available data. Results A total of 16 studies met inclusion criteria. Across 15 studies encompassing 1335 very preterm/VLBW children, MDI scores were strongly predictive for later cognitive development, r=0.61 (95%CI: 0.57-0.64), p<0.001. The relationship between MDI scores and later cognitive development was not mediated by birth weight (p=0.56), gestational age (p=.70), and time interval between assessments (p=0.55). Across four studies including 465 very preterm/ VLBW children, PDI scores were moderately predictive for later motor function, r=0.32 (95%CI: 0.22-0.40), p<0.001. Conclusions In very preterm/VBLW children, MDI scores explain 37% of the variance in later cognitive functioning, whereas PDI scores explain 10% of later motor development. Thus a large proportion of the variance remains unexplained, underlining the importance of enhancing prediction of developmental outcomes.
Background and AimsThe amino acid glutamine has been shown to reduce the number of serious neonatal infections in very preterm children (< 32 weeks of gestation), which may benefit long term brain development. The aim of this study was to elucidate potential effects of glutamine supplementation on brain development in very preterm children at school-age. Methods First, we investigated growth trajectories of head circumference, weight, and length in the first year for 65 very preterm children that originally participated in a randomized controlled trial on enteral glutamine supplementation between day 3 and 30 of life. Second, we measured brain structure volumes and white matter integrity for 52 very preterm children at school-age, using magnetic resonance imaging (MRI) and Diffusion Tensor Imaging (DTI), respectively. Furthermore, differences in functional outcomes were explored. Group differences were tested using ANOVA statistics. Results Glutamine supplementation was associated with improved growth trajectories of head circumference in the first year of life (d=0.66, p=0.03). Furthermore, glutamine supplementation increased white matter (d=0.54, p=0.03), hippocampus (d=0.47, p=0.02), and brain stem (d=0.54, p=0.04) volumes at school-age. All differences were strongly related with the number of serious neonatal infections (all p<0.02). Glutamine supplementation did not influende measures of motor, cognitive, and behavioral functioning at school-age. Conclusions We found evidence that reduction of serious infections by neonatal glutamine supplementation improves head growth in the first year of life, as well as brain structure volumes at school-age. This suggests an early programming effect of nutritional intervention with enteral glutamine.
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