Determinants of Developmental Performance of Very Lowbirthweight Survivors at One and Two Years of Age

Abstract

SUMMARY The developmental outcome of 61 very low‐birthweight infants was studied prospectively by means of the Bayley Scales of Infant Development at one and two years of age, corrected for prematurity. Preliminary analysis revealed that the mean scores for mental and psychomotor development were within the normal limits at both testing occasions. However, further analysis showed that there was a significant decrease in mental development scores from one to two years of age, due primarily to an increase in the numbers of low‐scoring children with ‘hyperactive’ behaviour at two years. Separate subgroups of children with suboptimal mental and psychomotor development scores were characterised at both testing occasions by the presence of ‘hyperactive’ behaviour and disability, usually of a minor degree. The presence of hyperactivity, disability and lowered mental performance may help in the early identification of children at increased developmental risk. RÉSUMÉ Les déterminants des performances de développement chez les survivants de très faible poids de naissance à Iàge de un et deux ans Le devenir dévelopmental de 61 nourrissons de très faible poids de naissance a étéétudié prospectivement à l'aide de la Bailey Scale of Infant Development aux âges de un et deux ans, après correction pour prématurité. Une analyse préliminaire révéla que les scores moyens de développement mental et psychomoteur étaient dans les limites de la normale aux deux âges. En fait, des études ultérieures montrérent une diminution significative des scores de développement mental entre lâge de un et deux ans avant tout en raison d'un accroissement du nombre des enfants avec faible performance et un comportement instable à làge de deux ans. Des sous‐groupes séparés d'enfants avec des scores de développement mental et psycho‐moteur sous‐optimaux sont apparus caractérisés aux deux examens successifs par un comportement instable et une incapacité, généralement mineure. La présence d'instabilité, d'incapacité et de performances mentales basses peut aider à l'dentification précoce des enfants exposés à un risque accru de troubles du développement. ZUSAMMENFASSUNG Maßstäbe für die Entwicklung von ein‐und zweijährigen Kindern, die ein sehr niedriges Geburtsgewicht hatten Die voraussichtliche Entwicklung von 61 Kindern mit sehr niedrigem Geburtsgewicht wurde im Alter von ein und zwei Jahren unter Verwendung der Bayley Scales of Infant Development unter Berücksichtigung der Unreife untersucht. Eine vorläufige Analyse ergab, daß die Mittelwerte für die geistige und psychomotorische Entwicklung bei beiden Untersuchungen innerhalb der Norm lagen. Weitere Analysen jedoch zeigten, daß die Parameter für die geistige Entwicklung im Alter von zwei Jahren deutlich schlechter waren, was primär durch eine Zunahme der Anzahl der Kinder mit schlechten Testergebnissen durch ‘hyperaktives' Verhalten im Alter von zwei Jahren bedingt war. Andere Untergruppen von Kindern mit niedrigen geistigen und psychomotorischen Entwicklungsscores fielen bei beiden Untersuchungen dur...

Trends in Neuromotor Behavior of Preterm and Fullterm Infants in the First Year of Life: A Preliminary Report

“…Other studies include a neurological examination either to specify which motor behaviors may place an infant at risk for developing disabilities (Drillien 1972, Stave and Ruvalo 1980, Ellenberg and Nelson 1981, Nelson and Ellenberg 1982 or to classify infants into diagnostic categories (Saint-Anne Dargassies 1979, Bennett el al. 1981, Palmer et al 1982, Teberg et al 1982, Astbury et al 1983). This approach does not provide a detailed account of neuromotor development needed to identify the subtle differences in motor behavior which can lead to identification of infants with co-ordination problems.…”

Visual Information Processing in Infancy

“…These included CNS haemorrhage, grade I1 to IV; hydrocephalus requiring ventriculostomy or shunt; neonatal seizures; pathological CT scan; abnormal neurological examination (if described as spastic diplegia/hemiplegia/quadriplegia or if there were significant abnormalities of muscle tone or reflexes); a birth defect involving the CNS; and microcephaly at birth and poor head-growth (<3*5cm in the first six weeks). All these conditions are known to be neurological risk-factors for later CNS development (Smith et al 1972, Krishnamoorthy et al 1979, Nelson and Ellenberg 1979, Johnson et al 1981, Siege1 et al 1982, Astbury et al 1983, Gross et al 1983, McDonald et al 1984). Infants with one or more of these conditions were classified as group 1 (dysfunctional).…”

Relationship Between Two‐year Behaviour and Neurodevelopmental Outcome at Five Years of Very Low‐birthweight Survivors

“…Three were unable to be assessed on the WPPSI because all three had spastic quadriplegia and one was also blind. The definition and incidence of major and minor disabilities in this group of children has already been reported (Astbury et al 1983). Two other children who had exhibited abnormally withdrawn, unco-operative behaviour, but not ADD, at two years were also excluded from analysis, leaving a sample of 57 children who had either ADD or normal behaviour at two years.…”

“…survivors (Desmond et al 1980, Dunn et d. 1980, Astbury et al 1983). Variation in the reported incidence of ADD may derive from differences in the nomenclature, which in the past has included hyperkinetic syndrome, hyperactive child syndrome, minimal brain damage and minimal cerebral dysfunction.…”

“…The present study reports on the outcome of a group of VLBW children born in 1979 and assessed twice during infancy, who have now reached school age. An earlier report (Astbury et al 1983) found that at two years of age abnormal behaviour during psychological testing, namely inattention, impulsivity and hyperactivity, discriminated a subgroup of children with significantly lower scores on the mental scale of the Bayley Scales of Infant Development (Bayley 1969) and with significantly more minor physical disabilities. However, there was no significant difference in mean birthweight between children with an attention deficit disorder (ADD*) and those with normal behaviour (1237 f 207g vs. 1154f207g).…”