Procedural pain in the neonatal intensive care unit triggers a cascade of physiological, behavioral and hormonal disruptions which may contribute to altered neurodevelopment in infants born very preterm, who undergo prolonged hospitalization at a time of physiological immaturity and rapid brain development. The aim of this study was to examine relationships between cumulative procedural pain (number of skin-breaking procedures from birth to term, adjusted for early illness severity and overall intravenous morphine exposure), and later cognitive, motor abilities and behavior in very preterm infants at 8 and 18 months corrected chronological age (CCA), and further, to evaluate the extent to which parenting factors modulate these relationships over time. Participants were N = 211 infants (n = 137 born preterm ≤32 weeks gestational age [GA] and n = 74 full-term controls) followed prospectively since birth. Infants with significant neonatal brain injury (periventricular leucomalacia, grade 3 or 4 intraventricular hemorrhage) and/or major sensori-neural impairments, were excluded. Poorer cognition and motor function were associated with higher number of skin-breaking procedures, independent of early illness severity, overall intravenous morphine, and exposure to postnatal steroids. The number of skin-breaking procedures as a marker of neonatal pain was closely related to days on mechanical ventilation. In general, greater overall exposure to intravenous morphine was associated with poorer motor development at 8 months, but not at 18 months CCA, however, specific protocols for morphine administration were not evaluated. Lower parenting stress modulated effects of neonatal pain, only on cognitive outcome at 18 months.

ABSTRACT. Objectives. To compare aerobic capacity, strength, flexibility, and activity level in extremely low birth weight (ELBW) adolescents at 17 years of age with term-born control subjects.Methods. . ELBW and control teens were assessed by a pediatric physiotherapist and completed components of the Canadian Physical Activity, Fitness and Lifestyle Appraisal and a self-assessment fitness and activity questionnaire. Continuous data were analyzed using MANOVA (group, gender) followed by t tests; categorical data were analyzed using the 2 test.Results. ELBW teens had lower aerobic capacity, grip strength, leg power, and vertical jump; could do fewer push-ups; had less abdominal strength as measured by curl-ups; had less lower back flexibility; and had tighter hamstrings. ELBW teens reported less previous and current sports participation, lower physical activity level, and poorer coordination compared with term-born control subjects. ELBW teens were also found to have more difficulty with maintenance of rhythm and cadence. Although ELBW teens rated themselves lower on all measures of sporting activity, they were as happy with their level of fitness as the control subjects.Conclusions. Compared with term-born control subjects, there are significant differences in motor performance in unimpaired ELBW survivors in late adolescence, reflected in aerobic capacity, strength, endurance, flexibility, and activity level. We conclude that these differences in fitness and physical activity are related to the interaction of effects of premature birth on the motor system together with a more inactive lifestyle. These findings have potential implications for later adult health problems. Pediatrics 2005;116:e58-e65. URL: www. pediatrics.org/cgi

Objective To identify perinatal and neonatal risk factors associated with developmental coordination disorder (DCD) in very low birthweight children (VLBW: <1250 g). Design Retrospective design with prospectively collected cohort. Setting Neonatal Follow-Up Program, Vancouver, Canada. Patients 157 VLBW children assessed at 4-5 years who were free of cerebral palsy or major neurological impairment and had full-scale IQ >70. Main outcome measure Movement Assessment Battery for Children (MABC).Results Using ≤15th percentile on the MABC as the cut-off, 42% of our cohort developed DCD. Perinatal variables significantly associated with DCD were male sex, lower gestational age and lower birth weight, but only male sex and low birth weight independently predicted DCD, accounting for 20% of the variance in MABC scores. Compared with children without motor impairment, children with DCD had greater postnatal steroid exposure, longer duration of ventilation, more days on oxygen and significant retinopathy of prematurity, but only postnatal steroid exposure was significant, accounting for an additional 3% of the variance in MABC scores. Boys performed more poorly than girls on all subtests of the MABC. Conclusions Male sex and low birth weight were significant predictors of DCD, suggesting that these infants should be followed for detection of this common, but under-recognised disorder. Future research aimed at identifying neural underpinnings of DCD and possible antecedents to the disorder is warranted.

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