Study of a Group of Extremely Preterm Infants (25

Abstract

The functional outcome of 49 extremely preterm infants (gestational age: 25—27 weeks) was studied at the corrected age of 12 months. Apart from pediatric follow-up, a full neurologic assessment and the Bayley Motor and Mental Scales of Infant Development was done. Emphasis was placed on postural control, spontaneous motility, hand function, and elicited infantile reactions. Special attention was given to symmetric development. The infants were then categorized as having optimal or nonoptimal or asymmetric outcome. Overall, an optimal outcome was found in 19 infants (39%) and nonoptimal outcome in 30 infants (61%), 7 of whom failed on all domains of function. Postural control had a significant influence on the different domains of development such as motility (P ≤ .001) and persistent infantile reactions (P ≤ .001) and slightly less on hand function (P = .08) and asymmetry (P = .06). The outcome on spontaneous motility was significantly related to the results on infantile reactions (P ≤ .005) and hand function (P = .05). Also, the score on the motor scale of the Bayley Developmental test was clearly related to outcome on spontaneous motility (P ≤ .001) and reactions ( P ≤ .02). Abnormal brain ultrasonograms were related to the asymmetry of the infantile reactions (P ≤ .05). Poor coordination of gross motor function will have consequences for appropriate visuomotor and sensorimotor integration, thereby hampering motor learning and later cognitive function, as is often described in preterm infants. It is suggested that the poor postural control found in many infants born preterm is the result of both myogenic and neurogenic deviations caused by the preterm birth and its nursing consequences. (J Child Neurol 2001;16:832—837).

Get full access to this article

View all access options for this article.

References

Ferrara TB , Hoekstra RE , Gaziano E. , et al: Changing outcome of extremely premature infants (less than or equal to 26 weeks' gestation and less than or equal to 750 gm): Survival and follow-up at a tertiary center. Am J Obstet Gynecol 1989;161:1114—1118.

Den Ouden L. , Verloove-Vanhorick SP , Zeben-van der Aa DM , et al: Neonatal neurological dysfunction in a cohort of very preterm and/or very low birthweight infants. Neuropediatrics 1990 ;21:66—71.

Nishida H. : Outcome of infants born preterm, with special emphasis on extremely low birthweight infants. Ballieres Clin Obstet Gynaecol 1993 ;7:611—631.

Cooke RW : Factors affecting survival and outcome at 3 years in extremely preterm infants . Arch Dis Child Neonatal Educ 1994;71:F28—F31.

Anderson AE , Wildin SR , Woodside M. , et al: Severity of medical and neurologic complications as a determinant of neurodevelopmental outcome at 6 and 12 months in very low birth weight infants. J Clin Neurol 1996;11:215—219.

Anderson AE , Swank P. , Wildin SR , et al: Modeling analysis of change in neurologic abnormalities in children born prematurely: A novel approach. J Child Neurol 1999;14:502—508.

Sternqvist K. , Svenningen NM : Ten-year follow-up of children born before 29 gestational weeks: Health, cognitive development, behavior and school achievement . Acta Paediatr 1999;88:557—562.

Weisglas-Kuperus N. , Uleman-Vleeschdrager M. , Baerts W. : Ventricular haemorrhages and hypoxic-ischaemic lesions in preterm infants: Neurodevelopmental outcome at 31/2 years. Dev Med Child Neurol 1987;29:623—629.

Astbury J. , Orgill AA , Bajuk B. , Yu VY : Neurodevelopmental outcome, growth and health of extremely low-birthweight survivors: How soon can we tell? Dev Med Child Neurol 1990;32:582—589.

10.

De Groot L , Hopkins B. , Touwen Bcl : Muscle power, sitting unsupported and trunk rotation in preterm infants. Early Human Dev 1995;43:37—46.

11.

De Groot L , de Groot CJ , Hopkins B. : An instrument to measure independent walking: Are there differences between preterm and fullterm infants? J Child Neurol 1997;12:37—41.

12.

Van der Fits IB , Flikweert ER , Stremmelaar EF , et al: Development of postural adjustments during reaching in preterm infants. Pediatr Res 1999;46:1—7.

13.

Touwen Bcl , Hadders-Algra M: Hyperextension of neck and trunk and shoulder retraction in infancy—A prognostic study. Neuropediatrics 1983;14:202—205.

14.

Georgieff MK , Bernbaum JC , Hoffman-Williamson M. , et al: Abnormal truncal muscle tone as a useful early marker for developmental delay in low birth weight infants. Pediatrics 1986;5:659—663.

15.

Georgieff MK , Bernbaum JC : Abnormal shoulder girdle tone in premature infants during their first 18 months of life. Pediatrics 1986;77:664—669.

16.

De Groot L : Posture and motility in preterm infants. Annotation . Dev Med Child Neurol 2000;42:65—68.

17.

Hadders-Algra M. , Brogren E. , Forssberg H. : Development of postural control—Differences between ventral and dorsal muscles?, review. Neurosci Biobehav Rev 1998;22:501—506.

18.

Samsom JF , de Groot L. : The influence of postural control on motility and hand function in a group of “high-risk” infants at one year of age. Early Hum Dev 2000;60:101—113.

19.

Plantinga Y. , Perdock J. , de Groot L. : Hand function in low-risk preterm infants: Its relation to muscle power regulation. Dev Med Child Neurol 1997;39:6—11.

20.

Trehub SE , Corter CM , Shosenberg N. : Neonatal reflexes: A search for lateral asymmetries, in Manual Specialization and the Developing Brain. Academic, 1983, 257—274.

21.

Marlow N. , Roberts BL , Cooke Rwi : Laterality and prematurity. Arch Dis Child 1989;64:1713—1716.

22.

Robichon F. , Levrier O. , Farnarier P. , et al: Developmental dyslexia: Atypical cortical asymmetries and functional significance. Eur J Neurol 2000;7:35—46.

23.

Dubowitz Lms , Dubowitz V. , Goldberg C. : Clinical assessment of gestational age in the newborn infant. J Pediatr 1970;77:1—10.

24.

Van der Meulen BF , Smrkovsky M. : Bayley Ontwikkelingsschalen. Lisse, The Netherlands, Swets en Zetlinger BV, 1993.

25.

Papile LA , Burstein J. , Burstein R. , et al: Incidence and evolution of subependymal and intraventricular hemorrhage: A study of infants with birth weights less than 1500 g. J Pediatr 1978;92: 529—534.

26.

Vries de LS , Eken P. , Dubowitz LM : The spectrum of leukomalacia using cranial ultrasound. Behav Brain Res 1992;49:1—6.

27.

Prechtl HF : Assessment and Significance of Behavioral States, in Berenberg SR (ed): Brain, Fetal and Infant. The Hague, M. Nijhoff Medical Publications, 1977, 79—90.

28.

Illingworth RS : The Development of the Infant and Young Child . Edinburgh: Churchill Livingstone , 1980.

29.

Msall ME , Rogers BT , Buck GM , et al: Functional status of extremely preterm infants at kindergarten entry. Dev Med Child Neurol 1993;35:312—320.

30.

Msall ME , Rogers BT , Allen M. , et al: Neurodevelopmental impairments and functional status in preschool children of very-low-birthweight status enrolled in surfactant clinical trials, abstract. Dev Med Child Neurol 2000;42(Suppl 3): B10:14—15.

31.

Hadders-Algra M. , Groothuis AM : Quality of general movements in infancy is related to neurological dysfunction, AHDH, and aggressive behavior. Dev Med Child Neurol 1999;41:381—391.

32.

Bozynski ME , DiPietro MA , Meisels SJ , et al: Cranial sonography and neurological examination at term and motor performance through 19 months of age. J Dev Behav Pediatr 1993;14:112—116.

33.

Edelman GM : Neural Darwinism: selection and reentrant signaling in higher brain function . Neuron 1993;10:115—125.

34.

Samsom JF , Groot de L, Hopkins B: Muscle power and medical history in high risk preterm infants at 3 months of corrected age. Neuropediatrics 1998;29:127—132.

35.

Kernell D. : The final common pathway in postural control—Developmental perspective . Neurosci Biobehav Rev 1998;22:479—484.

36.

Doyle LW , Permezel M. , Ford GW , et al: The obstetrician and the extremely immature fetus (24—26 weeks) outcome to 5 years of age. Aust N Z Obstet Gynaecol 1994;34:421—424.

37.

Blackman JA : Neonatal intensive care: Is it worth it? Developmental sequelae of very low birthweight. Pediatr Clin North Am 1991;38:1497—1511.

Study of a Group of Extremely Preterm Infants (25—27 Weeks)

Abstract

Get full access to this article

References