Among extremely preterm children, cognitive and neurologic impairment is common at school age. A comparison with their classroom peers indicates a level of impairment that is greater than is recognized with the use of standardized norms.

BACKGROUND. Studies of very preterm infants have demonstrated impairments in multiple neurocognitive domains. We hypothesized that neuromotor and executive-function deficits may independently contribute to school failure.

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Motor development in very preterm children differs in several important ways from that of children born at full term. Variability is common, although the anatomic and physiologic bases for that variability are often poorly understood. Motor patterns over the first postnatal year may depend on behaviours learned during often long periods of neonatal intensive care. The normal pattern of development may be modified by disturbances of brain function caused both by the interruption of normal brain maturation ex-utero and the superimposition of focal brain injuries following very preterm birth. Abnormal patterns of development over the first year may evolve into clear neuromotor patterns of cerebral palsy or resolve, as "transient dystonias." Cerebral palsy is associated with identified patterns of brain injury secondary to ischaemic or haemorrhagic lesions, perhaps modified by activation of inflammatory cytokines. Cerebral palsy rates have not fallen as might be expected over the past 10 years as survival has improved, perhaps because of increasing survival at low gestations, which is associated with the highest prevalence of cerebral palsy. Children who escape cerebral palsy are also at risk of motor impairments during the school years. The relationship of these impairments to perinatal factors or to neurological progress over the first postnatal year is debated. Neuromotor abnormalities are the most frequent of the "hidden disabilities" among ex-preterm children and are thus frequently associated with poorer cognitive ability and attention deficit disorders. Interventions to prevent cerebral palsy or to reduce these late disabilities in very preterm children are needed.

Extremely preterm children have a continuum of poor respiratory health over the first 6 years, which is exacerbated by smoking during pregnancy and in the home.

NotesOnline First articles must include the digital object identifier (DOIs) and date of initial publication. establish publication priority; they are indexed by PubMed from initial publication. Citations to may be posted when available prior to final publication Growth and BP in extreme prematurity 2 ABSTRACT Background: Preterm children are at risk for reduced growth in early childhood, which may predispose them to later changes in blood pressure. We studied growth and blood pressure (BP) in extremely preterm (EP) children at age 6 years.Methods: We evaluated children who were born at 25 completed weeks of gestation or less in the United Kingdom and Ireland in 1995 when they reached early school age. Children underwent standardized assessments, including auxology and sitting blood pressure.Results: Of 308 surviving children, 241 (78 percent) were assessed at a median age of 6 years 4 months; 160 full term classmates acted as a comparison group. Compared to classmates, EP children were 1.2 standard deviations (SD) lighter, 0.97SD shorter, BMI was 0.95SD lower and head circumference 1.3SD lower. Compared to 2.5 years of age, EP children showed catch up in terms of weight by 0.37SD, height by 0.42SD and head circumference by 0.13SD. Systolic and diastolic BP were lower by 2.3mmHg and 2.4mmHg respectively in EP children but these differences were accounted for by differences in height and BMI. Maternal smoking in pregnancy was associated with lower BP, children born before 24 weeks had higher systolic and children given postnatal steroids higher diastolic pressures.Conclusions: Poor postnatal growth seen after birth and at in the third year persists into school age. Catch up growth reduces some of the early deficit but is least for head growth. Despite serious postnatal growth restriction blood pressure appears similar in both EP and term classmates.

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SUMMARYBackground: Local delivery of therapeutic agents to the stomach may be a useful strategy in the treatment of Helicobacter pylori infection. We aimed to see whether the intragastric distribution and gastric retention of a therapeutic agent could be improved, either by giving omeprazole or by dosing after a meal.Methods: Twelve healthy volunteers took part in this double‐blind placebo‐controlled crossover study comparing the effects of omeprazole 20 mg twice daily for 5 days with placebo, and the fasted with the fed state, on the gastric emptying and intragastric distribution of a soluble scintigraphic marker contained in a drug capsule.Results: Dosing after food profoundly prolonged gastric residence of the drug label, prolonging mean time to 50% emptying (T50) from 0.5 ± 0.1 h in the fasted state to 2.0 ± 0.2 h when given after food. Food also improved intragastric distribution by increasing delivery to the body and fundus. Omeprazole enhanced the effect of food, prolonging T50 to 2.9 ± 0.3 h, but had no effect in fasted subjects.Conclusions: Dosing after food markedly improves the aspects of local drug delivery to the stomach investigated in this study, and omeprazole enhances this effect. Post‐prandial dosing may, therefore, be useful for improving delivery of some anti‐Helicobacter agents.