, Dieter Wolke, PhD, Dr rer nat hc a,d abstract BACKGROUND: Very preterm (VP; gestational age ,32 weeks) and very low birth weight (VLBW; ,1500 g) births are related to impaired cognitive function across the life span. It is not known how stable cognitive functions are from childhood to adulthood for VP/VLBW compared with term-born individuals and how early adult cognitive function can be predicted.

Background. Children born very preterm (VP< 32 weeks gestation) and/or with very low birth weight (VBLW< 1500 gr; subsequently VP/VLBW) have been previously reported to have more cognitive impairment and specific executive functioning problems than term children; however, it remains unclear whether these problems persist into adulthood. This study aimed to examine general intelligence (IQ) and executive functioning (EF) of adults born VP/VLBW in comparison to term controls. Additionally, the effects of smallness for gestational age (SGA) and family socio-economic status (SES) at birth were investigated. Results. VP/VLBW adults scored significantly lower than controls in IQ and EF. There was a 1.16 standard deviation (SD) unit difference between the VP/VLBW and controls in FullScale IQ. VP/VLBW adults were found to have general and multiple cognitive problems rather than specific deficits in EF. SGA was not a significant predictor of cognitive impairment. Family SES had a significant impact on general intelligence in both VP/VLBW and term controls. The SES effects amounted to 1.13 SD units between individuals born into high versus low SES. Methods. The Bavarian Longitudinal Conclusions.No narrowing of cognitive deficits between VP/VLBW and term control adults to previous childhood assessments at 6 years of age was found. VP/VLBW adults do not outgrow their cognitive problems despite many receiving special educational support in childhood. Low family SES at birth has similar additive adverse effects on cognitive performance in VP/VLBW and term offspring.

We conclude that CRP could be a key parameter for individually guiding the duration of antibiotic treatment in a major subgroup of newborns with suspected bacterial infection. This approach would allow considerably shorter courses of antibiotic therapy.

(2013) Poor attention rather than hyperactivity/impulsivity predicts academic achievement in very preterm and full-term adolescents. Psychological Medicine, Vol.43 (No.1). pp. 183-196. ISSN 0033-2917 Permanent WRAP url: http://wrap.warwick.ac.uk/52783/ Copyright and reuse:The Warwick Research Archive Portal (WRAP) makes this work by researchers of the University of Warwick available open access under the following conditions. Copyright © and all moral rights to the version of the paper presented here belong to the individual author(s) and/or other copyright owners. To the extent reasonable and practicable the material made available in WRAP has been checked for eligibility before being made available.Copies of full items can be used for personal research or study, educational, or not-forprofit purposes without prior permission or charge. Provided that the authors, title and full bibliographic details are credited, a hyperlink and/or URL is given for the original metadata page and the content is not changed in any way. Publisher's statement: Copyright © Cambridge University Press 2012 A note on versions:The version presented in WRAP is the published version or, version of record, and may be cited as it appears here. Background. Very preterm (VP) children are at particular risk for attention deficit/hyperactivity disorder (ADHD) of the inattentive subtype. It is unknown whether the neurodevelopmental pathways to academic underachievement are the same as in the general population. This study investigated whether middle childhood attention or hyperactivity/impulsivity problems are better predictors of VP adolescents' academic achievement.Method. In a geographically defined prospective whole-population sample of VP (<32 weeks gestation) and/or very low birth weight (<1500 g birth weight) (VLBW/VP ; n=281) and full-term control children (n=286) in South Germany, ADHD subtypes were assessed at 6 years 3 months and 8 years 5 months using multiple data sources. Academic achievement was assessed at 13 years of age.Results. Compared with full-term controls, VLBW/VP children were at higher risk for ADHD inattentive subtype [6 years 3 months : odds ratio (OR) 2.8, p<0.001 ; 8 years 5 months : OR 1.7, p=0.020] but not for ADHD hyperactiveimpulsive subtype (6 years 3 months : OR 1.4, p=0.396 ; 8 years 5 months : OR 0.9, p=0.820). Childhood attention measures predicted academic achievement in VLBW/VP and also full-term adolescents, whereas hyperactive/ impulsive behaviour did not.Conclusions. Attention is an important prerequisite for learning and predicts long-term academic underachievement. As ADHD inattentive subtype and cognitive impairments are frequent in VLBW/VP children, their study may help to identify the neurofunctional pathways from early brain development and dysfunction to attention problems and academic underachievement.

Preterm birth is a leading cause for impaired neurocognitive development with an increased risk for persistent cognitive deficits in adulthood. In newborns, preterm birth is associated with interrelated white matter (WM) alterations and deep gray matter (GM) loss; however, little is known about the persistence and relevance of these subcortical brain changes. We tested the hypothesis that the pattern of correspondent subcortical WM and GM changes is present in preterm-born adults and has a brain-injury-like nature, i.e., it predicts lowered general cognitive performance. Eighty-five preterm-born and 69 matched term-born adults were assessed by diffusion- and T1-weighted MRI and cognitive testing. Main outcome measures were fractional anisotropy of water diffusion for WM property, GM volume for GM property, and full-scale IQ for cognitive performance. In preterm-born adults, reduced fractional anisotropy was widely distributed ranging from cerebellum to brainstem to hemispheres. GM volume was reduced in the thalamus, striatum, temporal cortices, and increased in the cingulate cortices. Fractional anisotropy reductions were specifically associated with GM loss in thalamus and striatum, with correlation patterns for both regions extensively overlapping in the WM of brainstem and hemispheres. For overlap regions, fractional anisotropy was positively related with both gestational age and full-scale IQ. Results provide evidence for extensive, interrelated, and adverse WM and GM subcortical changes in preterm-born adults. Data suggest persistent brain-injury-like changes of subcortical-cortical connectivity after preterm delivery.

Objective: To assess long term changes in cardiac morphology and function in survivors of severe twin to twin transfusion syndrome (TTTS) after intrauterine laser coagulation of placental anastomoses. Design: Prospective follow up of fetuses with severe TTTS treated by laser coagulation of intrauterine placental anastomoses. Fetal echocardiography and Doppler studies of feto-placental haemodynamic function were performed at the time of laser coagulation (median gestational age of 21.7 weeks). Postnatal cardiac follow up included a detailed echocardiographic study of systolic and diastolic cardiac function at a median age of 21.1 months. Setting: Paediatric cardiology unit. Patients: 89 survivors from 73 consecutive pregnancies with severe TTTS. Results: Before laser treatment, 28 of 51 (54.9%) recipient twins had typical signs of cardiac dysfunction due to volume overload and 9 of 38 (23.7%) donors had absent or reversed end diastolic flow in the umbilical artery. Echocardiography was normal in 87.6% of the survivors (34 of 38 donors, 44 of 51 recipients). The prevalence of congenital heart disease and particularly of pulmonary stenosis, which was recorded only in recipients, was increased in comparison with the general population (congenital heart disease, 10 of 89 (11.2%) v 0.3%; pulmonary stenosis, 4 of 51 (7.8%) v 0.03%). Findings before laser treatment were not correlated with the development of structural heart disease. Conclusions: Despite the high rate and severity of prenatal cardiac overload in recipients, the majority of cases of TTTS are normalised after laser treatment. However, given the increased prevalence of congenital heart disease and in particular pulmonary stenosis, intrauterine and postnatal follow up is warranted.

Self-reports of adults born preterm at VLBW reveal a heightened risk for internalizing problems and socially avoidant personality traits together with a lowered risk for externalizing problem types. Our findings support the view that preterm birth constitutes an early vulnerability factor with long-term consequences on the individual into adulthood.

Background Very preterm (VP; gestational age <32 weeks) and very low birth weight (VLBW; <1500 grams) is related to attention problems in childhood and adulthood. The stability of these problems into adulthood is not known. Methods The Bavarian Longitudinal Study is a prospective cohort study that followed 260 VP/VLBW and 229 term‐born individuals from birth to adulthood. Data on attention were collected at 6, 8, and 26 years of age, using parent reports, expert behavior observations, and clinical ADHD diagnoses. Results At each assessment, VP/VLBW individuals had significantly more attention problems, shorter attention span, and were more frequently diagnosed with ADHD than term‐born comparisons. In both VP/VLBW and term‐born individuals, overall, attention span increased and attention problems decreased from childhood to adulthood. Attention problems and attention span were more stable over time for VP/VLBW than term‐born individuals. Similarly, ADHD diagnoses showed moderate stability from childhood to adulthood in VP/VLBW, but not in term‐born individuals. However, when those with severe disabilities were excluded, differences between VP/VLBW and term‐born individuals reduced. Conclusions Despite improvement in attention regulation from childhood to adulthood, children born very preterm remained at increased risk for attention problems in adulthood. In contrast, term‐born children with clinical attention problems outgrew these by adulthood. As inattentive behavior of VP/VLBW children may be overlooked by teachers, it may be necessary to raise awareness for school intervention programs that reduce attention problems in VP/VLBW children.