BackgroundInfants born <30 weeks’ gestation are at increased risk of long term neurodevelopmental problems compared with term born peers. The predictive value of neurobehavioural examinations at term equivalent age in very preterm infants has been reported for subsequent impairment. Yet there is little knowledge surrounding earlier neurobehavioural development in preterm infants prior to term equivalent age, and how it relates to perinatal factors, cerebral structure, and later developmental outcomes. In addition, maternal psychological wellbeing has been associated with child development. Given the high rate of psychological distress reported by parents of preterm children, it is vital we understand maternal and paternal wellbeing in the early weeks and months after preterm birth and how this influences the parent–child relationship and children’s outcomes. Therefore this study aims to examine how 1) early neurobehaviour and 2) parental mental health relate to developmental outcomes for infants born preterm compared with infants born at term.Methods/DesignThis prospective cohort study will describe the neurobehaviour of 150 infants born at <30 weeks’ gestational age from birth to term equivalent age, and explore how early neurobehavioural deficits relate to brain growth or injury determined by magnetic resonance imaging, perinatal factors, parental mental health and later developmental outcomes measured using standardised assessment tools at term, one and two years’ corrected age. A control group of 150 healthy term-born infants will also be recruited for comparison of outcomes. To examine the effects of parental mental health on developmental outcomes, both parents of preterm and term-born infants will complete standardised questionnaires related to symptoms of anxiety, depression and post-traumatic stress at regular intervals from the first week of their child’s birth until their child’s second birthday. The parent–child relationship will be assessed at one and two years’ corrected age.DiscussionDetailing the trajectory of infant neurobehaviour and parental psychological distress following very preterm birth is important not only to identify infants most at risk, further understand the parental experience and highlight potential times for intervention for the infant and/or parent, but also to gain insight into the effect this has on parent–child interaction and child development.

AIM Preschool feeding disorders are common and debilitating and are associated with a range of developmental and medical issues. Parent report allows assessment of feeding in a naturalistic environment over time, with advantages over time-limited, clinic-based observations. However, little is understood about the limitations and advantages of current parent-report measures. We aimed to systematically review the psychometrics and clinometrics of parent-administered feeding questionnaires.METHOD Five search engines were used to identify questionnaires that met inclusion criteria, i.e. being norm-or criterion-referenced, child focused, appropriate for preschool children, and measured two or more feeding domains (e.g. dysphagia/oral motor delay, food refusal). RESULTSIn total 3535 abstracts were identified and 215 full-text articles were evaluated. Five questionnaires met the criteria. The Behavioral Pediatrics Feeding Assessment Scale (BPFAS) was the most reliable questionnaire identified, with good test-retest reliability and internal consistency. More predictive and concurrent validity data was available for the BPFAS, the Mealtime Behavior Questionnaire, and the Montreal Children's Hospital Feeding Scale than for other measures.INTERPRETATION Further research is needed on the psychometric properties of feeding questionnaires used in research and clinical practice. To date, the BPFAS has the most comprehensive reliability and validity data of any parent-administered feeding questionnaire for preschool children.Paediatric feeding disorders can be associated with neurological vulnerability and are the subject of increasing research and clinical attention.1,2 While conditions such as cerebral palsy (CP) have long been understood to impact on feeding function, other groups with neurodevelopmental and medical needs are increasingly recognized as being at risk for chronic feeding difficulties.1-3 Furthermore, feeding difficulties may occur in children without a known medical or developmental aetiology. 1,4 By 5 years of age, typically developing children have mastered most of their oral motor milestones, and are able to participate more fully in family mealtimes.5 They are at the end of a critical or sensitive period that is theorized to exist up to about 5 years. 1,6 After this, feeding skills may be more difficult to acquire because of decreased neuroplasticity. 1,6 Feeding disorders of any duration can have a significant impact on a child's growth and development, general health, and family relationships. 3,7,8 As a result, it is important to understand the presentation of feeding disorders in the preschool years to optimize the development of skills and minimize any of these negative impacts.The multifactorial and interactive nature of feeding disorders means that thorough assessment is time-consuming and requires careful consideration. Standard assessment typically includes a case history that covers family, medical, and developmental history, and details of the child's past and current feeding; physical examinati...

Aim To examine the associations between Prechtl's General Movements Assessment (GMA), conducted from birth to term‐equivalent age, and neurodevelopmental outcomes at 12 months corrected age, in infants born very preterm. Method One hundred and thirty‐seven infants born before 30 weeks' gestation had serial GMA (categorized as ‘normal’ or ‘abnormal’) before term and at term‐equivalent age. At 12 months corrected age, neurodevelopment was assessed using the Alberta Infant Motor Scale (AIMS); Neurological, Sensory, Motor, Developmental Assessment (NSMDA); and Touwen Infant Neurological Examination (TINE). The relationships between GMA at four time points and 12‐month neurodevelopmental assessments were examined using regression models. Results Abnormal GMA at all time points were associated with worse continuous scores on the AIMS, NSMDA, and TINE (p<0.05). Abnormal GMA before term and at term‐equivalent age were associated with increased odds of mild–severe dysfunction on the NSMDA (odds ratio [OR] 4.26, 95% confidence interval [CI] 1.55–11.71, p<0.01; and OR 4.16, 95% CI 1.55–11.17, p<0.01 respectively) and abnormal GMA before term with increased odds of suboptimal–abnormal motor function on the TINE (OR 2.75, 95% CI 1.10–6.85, p=0.03). Interpretation Abnormal GMA before term and at term‐equivalent age were associated with worse neurodevelopment at 12 months corrected age in children born very preterm. What this paper adds Abnormal general movements before term predict developmental deficits at 1 year in infants born very preterm. General Movements Assessment before term identifies at‐risk infants born very preterm.

Although neurodevelopmental allied health teams and standardised neurobehavioural/neurological assessments are valued by many, there was little consistency across Australian and New Zealand neonatal nurseries.

ObjectiveTo compare the physiological stress responses of infants born <30 weeks’ gestational age when undergoing clustered nursing cares with standardised neurobehavioural assessments in neonatal nurseries.Design/methodsThirty-four infants born <30 weeks’ gestation were recruited from a tertiary neonatal intensive care unit. Heart rate (HR) and oxygen saturation were recorded during clustered nursing cares and during standardised neurobehavioural assessments (including the General Movements Assessment, Hammersmith Neonatal Neurological Examination and Premie-Neuro Assessment). Two assessors extracted HR and oxygen saturations at 5 s intervals, with HR instability defined either as tachycardia (HR >180 beats per minute (bpm)) or bradycardia (HR <100 bpm). Oxygen desaturations were defined as SpO2<90%. Physiological stability was compared between nursing cares and neurobehavioural assessments using linear (for continuous outcomes) and logistic (HR instability and oxygen desaturation) regression.ResultsCompared with clustered nursing cares HR was lower (mean difference −5.9 bpm; 95% CI −6.5 to 5.3; P<0.001) and oxygen saturation higher (mean difference 2.4%; 95% CI 2.1% to 2.6%; P<0.001) during standardised neurobehavioural assessments. Compared with clustered nursing cares neurobehavioural assessments were also associated with reduced odds of tachycardia (OR 0.44, 95% CI 0.22 to 0.86), HR instability (OR 0.43, 95% CI 0.22 to 0.85) and oxygen desaturation (OR 0.43, 95% CI 0.26 to 0.70).ConclusionsStandardised neurobehavioural assessments are associated with less physiological stress than clustered nursing cares in infants aged 29–32 weeks’ postmenstrual age, and are therefore possible without causing undue physiological disturbance in medically stable infants.