ABSTRACT. Objective. To compare academic and cognitive ability, attention, attitudes, and behavior of extremely low birth weight (ELBW) adolescents who are free of major impairments at 17 years of age with termborn control subjects.Methods. Between January 31, 1981, and February 9, 1986, 250 infants of <800 g were admitted for intensive care in British Columbia, 98 (39%) of whom survived to late adolescence. Teens with major sensorimotor handicaps and/or IQ <70 were excluded (n ‫؍‬ 19). Of the 79 eligible ELBW teens, 53 (67%) were assessed at 17. Results. The ELBW group showed lower cognitive scores (vocabulary, block design, and digit symbol) and academic skills (reading and arithmetic) compared with control subjects, with no gender differences. There were no differences in attention between the 2 groups using a repetitive computer task. ELBW teens reported lower scholastic, athletic, job competence, and romantic confidence and viewed themselves as more likely to need help from others in finding a job. In the behavioral domain, parents reported their ELBW teens to display more internalizing, more externalizing, and more total problems than the control teens, with ELBW boys showing more problems. ELBW teens showed a higher percentage of clinically significant behavior problems than control subjects.Conclusions. In a provincial cohort of unimpaired survivors of birth weight <800 g, psychosocial and educational vulnerabilities persist into late adolescence and may complicate the transition to adult life compared with their peers. Pediatrics 2004;114:e725-e732. URL: www. pediatrics.org/cgi/doi/10.1542/peds.2004-0932; premature infants, very low birth weight infants, follow-up studies, developmental disabilities.ABBREVIATIONS. ELBW, extremely low birth weight; VLBW, very low birth weight; ADHD, attention-deficit/hyperactivity disorder; NICU, neonatal intensive care unit; WISC, Wechsler Intelligence Scale for Children; SD, standard deviation; SES, socioeconomic status; WAIS-III, Wechsler Intelligence Scale for Adults, Third Edition; WRAT-3, Wide Range Achievement Test, Third Edition; CPT, Continuous Performance Task; CBCL, Child Behavior Check List. I n the past 3 decades, major advances in neonatal intensive care technology and the development of functional regionalized perinatal networks have made medical services accessible to the majority of high-risk births and have led to increased survival of infants of extremely low birth weight (ELBW Յ800 g). There is now a significant body of literature describing the psychosocial and educational outcomes of infants of Ͻ1000 g birth weight born in the 1980s at school age, which include small numbers of infants of 800 g or less. Long-term neurodevelopmental, behavioral, cognitive, and motor sequelae of prematurity have been documented extensively, [1][2][3][4][5][6][7][8] including reports that predate the increase in survival of extremely small and sick infants. [9][10][11][12] In addition to children with frank neurologic and sensory impairment, a spectrum of neurodevelopm...

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

The occurrenceof postconcussive symptoms (PCS) following mild traumatic brain injury (TBI) in children may depend on cognitive reserve capacity. This prospective, longitudinal study examined whether the relationship between mild TBI and PCS is moderated by cognitive ability, which served as a proxy for cognitive reserve. Participants included 182 children with mild TBI and 99 children with orthopedic injuries (OI), ranging from 8 to 15 years of age when injured. Mild TBI were classified as complicated (n = 32) or uncomplicated (n = 150) depending on whether they were associated with trauma-related intracranial abnormalities on magnetic resonance imaging. PCS were assessed initially within 3 weeks of injury, and again at 1, 3, and 12 months post injury. The initial assessment also included standardized tests of children's cognitive skills and retrospective parent ratings of pre-injury symptoms. Hierarchical linear modeling indicated that ratings of PCS were moderated jointly by cognitive ability and injury severity. Children of lower cognitive ability with a complicated mild TBI were especially prone to cognitive symptoms across time according to parents and to high acute levels of PCS according to children's self-ratings. Cognitive reserve is an important moderator of the outcomes of mild TBI in children and adolescents.

Longitudinal patterns of functional deficits were investigated in 37 children with severe traumatic brain injuries (TBI), 40 children with moderate TBI, and 44 children with orthopedic injuries (OI). They were from 6 to 12 years of age when injured. Their neuropsychological, behavioral, adaptive, and academic functioning was assessed at 6 months, 12 months, and 3-5 years post injury. Functional deficits (<10th percentile for age) were identified within each outcome domain at each occasion. Children were classified into four a priori longitudinal patterns of outcomes within domains (i.e., no deficits, improvement, deterioration, persistent deficits). In multinomial logistic regression analyses, severe TBI predicted an increased likelihood of persistent deficits in all outcome domains, as well as deterioration in behavioral functioning and improvement in neuropsychological, adaptive, and academic functioning. Severe TBI also predicted a greater total number of functional deficits across domains at each occasion. However, many children with severe TBI showed no deficits from 6 months to 4 years post injury in one or more outcome domains. The findings help to clarify the course of recovery for individual children following TBI.

Recent attention has begun to focus on the impact of childhood traumatic brain injury (TBI) on the family. This study examined the impact of mild to moderate childhood TBI on parental ratings of well and injured siblings' behaviours in relation to well siblings' ratings of the impact of injury and the sibling relationship. Parents of 10 children with TBI and 10 children with orthopaedic injury rated both injured and well siblings' behaviours using the Child Behaviour Checklist (CBCL). Well siblings completed the Sibling Impact Questionnaire (SIQ) and Sibling Relationship Questionnaire (SRQ). Results indicated that children with TBI exhibited significantly more externalising and total behaviours than children with orthopaedic injury, while well siblings of children with TBI exhibited more internalising behaviours than siblings of children with orthopaedic injury. Well siblings' ratings of the impact of the injury and sibling relationship did not differ significantly across groups. The behaviours of well siblings and their ratings of injury impact and sibling relationship are examined in relation to the behaviours of the injured siblings for the two groups. The implications of the findings are examined in terms of the need to involve siblings in the rehabilitation process.