scholarly journals School-age outcomes following intraventricular haemorrhage in infants born extremely preterm

2020 ◽  
Vol 106 (1) ◽  
pp. 4-8 ◽  
Author(s):  
Nicky Laura Hollebrandse ◽  
Alicia J Spittle ◽  
Alice C Burnett ◽  
Peter J Anderson ◽  
Gehan Roberts ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Executive Function ◽  
Motor Function ◽  
Intraventricular Haemorrhage ◽  
Academic Skills ◽  
Intellectual Ability ◽  
Low Grade ◽  
Cranial Ultrasound ◽  
Neurodevelopmental Outcomes ◽  
Extremely Preterm

ObjectiveTo determine the associations of different grades of intraventricular haemorrhage (IVH), particularly grades 1 and 2, with neurodevelopmental outcomes at 8 years of age in children born extremely preterm.DesignPopulation-based cohort study.SettingState of Victoria, Australia.PatientsSurvivors born at <28 weeks’ gestational age (n=546) and matched term-born controls (n=679) from three distinct eras, namely, those born in 1991–1992, 1997 and 2005.ExposureWorst grade of IVH detected on serial neonatal cranial ultrasound.Outcome measuresIntellectual ability, executive function, academic skills, cerebral palsy and motor function at 8 years.ResultsThere was a trend for increased motor dysfunction with increasing severity of all grades of IVH, from 24% with no IVH, rising to 92% with grade 4 IVH. Children with grade 1 or 2 IVH were at higher risk of developing cerebral palsy than those without IVH (OR 2.24, 95% CI 1.21 to 4.16). Increased rates of impairment in intellectual ability and academic skills were observed with higher grades of IVH, but not for grade 1 and 2 IVH. Parent-rated executive functioning was not related to IVH.ConclusionWhile low-grade IVH is generally considered benign, it was associated with higher rates of cerebral palsy in school-aged children born EP, but not with intellectual ability, executive function, academic skills or overall motor function. Higher grades of IVH were associated with higher rates and risks of impairment in motor function, intellectual ability and some academic skills, but not parental ratings of executive function.

scholarly journals Cerebral palsy in preterm infants

2016 ◽  
Vol 73 (4) ◽  
pp. 343-348 ◽  
Author(s):  
Cila Demesi-Drljan ◽  
Aleksandra Mikov ◽  
Karmela Filipovic ◽  
Snezana Tomasevic-Todorovic ◽  
Aleksandar Knezevic ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Preterm Birth ◽  
Motor Function ◽  
Gestational Age ◽  
Significant Risk ◽  
Gross Motor ◽  
Gross Motor Function ◽  
Extremely Preterm ◽  
Significant Difference ◽  
Associated Conditions

Background/Aim. Cerebral palsy (CP) is one of the leading causes of neurological impairment in childhood. Preterm birth is a significant risk factor in the occurrence of CP. Clinical outcomes may include impairment of gross motor function and intellectual abilities, visual impairment and epilepsy. The aim of this study was to examine the relationships among gestational age, type of CP, functional ability and associated conditions. Methods. The sample size was 206 children with CP. The data were obtained from medical records and included gestational age at birth, clinical characteristics of CP and associated conditions. Clinical CP type was determined according to Surveillance of Cerebral Palsy in Europe (SCPE) and topographically. Gross motor function abilities were evaluated according to the Gross Motor Function Classification System (GMFCS). Results. More than half of the children with CP were born prematurely (54.4%). Statistically significant difference was noted with respect to the distribution of various clinical types of CP in relation to gestational age (p < 0.001). In the group with spastic bilateral CP type, there is a greater proportion of children born preterm. Statistically significant difference was noted in the functional classification based on GMFCS in terms of gestational age (p = 0.049), children born at earlier gestational age are classified at a higher GMFCS level of functional limitation. The greatest percentage of children (70.0%) affected by two or more associated conditions was found in the group that had extremely preterm birth, and that number declined with increasing maturity at birth. Epilepsy was more prevalent in children born at greater gestational age, and this difference in distribution was statistically significant (p = 0.032). Conclusion. The application of antenatal and postnatal protection of preterm children should be a significant component of the CP prevention strategy.

66 Long-term survival and neurodevelopmental outcomes of very-preterm infants born in Canada between 2009 and 2016

2021 ◽  
Vol 26 (Supplement_1) ◽  
pp. e46-e47
Author(s):  
M Florencia Ricci ◽  
Prakesh Shah ◽  
Diane Moddemann ◽  
Ruben Alvaro ◽  
Eugene Ng ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Hearing Impairment ◽  
Late Onset ◽  
Cognitive Outcome ◽  
Neurodevelopmental Outcomes ◽  
Perinatal Medicine ◽  
Term Survival ◽  
Extremely Preterm ◽  
Neurodevelopmental Impairment ◽  
Improvement Programs

Abstract Primary Subject area Neonatal-Perinatal Medicine Background Quality improvement programs across Canadian Neonatal Network (CNN) sites have led to increased neonatal survival without major neonatal morbidity among infants born extremely preterm. The next step is to determine if such activities impact longer-term survival and neurodevelopmental outcomes. Objectives This cohort study aimed to compare death or significant neurodevelopmental impairment (sNDI) (Bayley-III scores &lt; 70, severe cerebral palsy, blind, or hearing aided) at 18-24 months corrected age among infants born &lt; 29 weeks’ gestation admitted to CNN sites, between 2 Epochs: 1 (2009-2012) and 2 (2013-2016). Secondary objectives included death or neurodevelopmental impairment (NDI) (Bayley-III &lt; 85, any cerebral palsy, visual or hearing impairment), death, sNDI, NDI, and components of neurodevelopmental impairment. Design/Methods Only sites with ≥ 70% follow-up rates were included. Differences in maternal-infant characteristics and neonatal morbidities were assessed by Pearson Chi-square and Student t-test testing. Adjusted odds ratios with 95% CIs were calculated for outcome change between the 2 Epochs, accounting for patient characteristic differences in the model. Results Study population included 4426 children; Epoch 1: 1895 (43%) and Epoch 2: 2531 (57%). In Epoch 2, more mothers received MgSO4 (56.3% vs. 28.4%; p&lt;0.01), antibiotics (69%vs.65.3%; p 0.01) and delayed cord clamping (37.1% vs. 31.3%; p 0.02), and fewer infants had SNAP-2 (illness severity score) &gt;20 (30.7% vs. 35.2%; p&lt;0.01) or late-onset sepsis (23.3% vs. 26.9%; p 0.01). See Table 1. Conclusion Significant reductions in rate of death or sNDI, and in visual and hearing impairment, were identified between Epoch 2 to Epoch 1. An increase in poor cognitive outcome rates requires further study.

Neurodevelopmental outcome descriptions in cohorts of extremely preterm children

2020 ◽  
Vol 105 (5) ◽  
pp. 510-519 ◽  
Author(s):  
Sharon Ding ◽  
Emma J Mew ◽  
Alyssandra Chee-A-Tow ◽  
Martin Offringa ◽  
Nancy J Butcher ◽  
...  
Keyword(s):  
Decision Making ◽  
Cerebral Palsy ◽  
Cognitive Function ◽  
Cohort Studies ◽  
Neurodevelopmental Outcomes ◽  
Outcome Reporting ◽  
Study Results ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Outcome Selection

Background and objectivesCaregivers and clinicians of extremely preterm infants (born before 26 weeks’ gestation) depend on long-term follow-up research to inform clinical decision-making. The completeness of outcome reporting in this area is unknown. The objective of this study was to evaluate the reporting of outcome definitions, selection, measurement and analysis in existing cohort studies that report on neurodevelopmental outcomes of children born extremely preterm.MethodsWe evaluated the completeness of reporting of ‘cognitive function’ and ‘cerebral palsy’ in prospective cohort studies summarised in a meta-analysis that assessed the effect of preterm birth on school-age neurodevelopment. Outcome reporting was evaluated using a checklist of 55 items addressing outcome selection, definition, measurement, analysis, presentation and interpretation. Reporting frequencies were calculated to identify strengths and deficiencies in outcome descriptions.ResultsAll 14 included studies reported ‘cognitive function’ as an outcome; nine reported both ‘cognitive function’ and ‘cerebral palsy’ as outcomes. Studies reported between 26% and 46% of the 55 outcome reporting items assessed; results were similar for ‘cognitive function’ and ‘cerebral palsy’ (on average 34% and 33% of items reported, respectively). Key methodological concepts often omitted included the reporting of masking of outcome assessors, methods used to handle missing data and stakeholder involvement in outcome selection.ConclusionsThe reporting of neurodevelopmental outcomes in cohort studies of infants born extremely preterm is variable and often incomplete. This may affect stakeholders’ interpretation of study results, impair knowledge synthesis efforts and limit evidence-based decision-making for this population.

scholarly journals Evidence for the Placenta-Brain Axis: Multi-Omic Kernel Aggregation Predicts Intellectual and Social Impairment in Children Born Extremely Preterm

2020 ◽  
Author(s):  
Hudson P Santos ◽  
Arjun Bhattacharya ◽  
Robert M Joseph ◽  
Lisa Smeester ◽  
Karl CK Kuban ◽  
...  
Keyword(s):  
Gestational Age ◽  
Complex Traits ◽  
External Validation ◽  
Social Function ◽  
Autism Spectrum ◽  
Intellectual Ability ◽  
Social Impairment ◽  
Neurodevelopmental Outcomes ◽  
Genome Wide ◽  
Extremely Preterm

AbstractBackgroundChildren born extremely preterm are at heightened risk for intellectual and social impairment, including Autism Spectrum Disorder (ASD). There is increasing evidence for a key role of the placenta in prenatal developmental programming, suggesting that the placenta may explain origins of neurodevelopmental outcomes.MethodsWe examined associations between placental genomic and epigenomic profiles and assessed their ability to predict intellectual and social impairment at age 10 years in 379 children from the Extremely Low Gestational Age Newborn (ELGAN) cohort. Assessment of intellectual ability (IQ) and social function was completed with the Differential Ability Scales-II (DAS-II) and Social Responsiveness Scale (SRS), respectively. Examining IQ and SRS allows for studying ASD risk beyond the diagnostic criteria, as IQ and SRS are continuous measures strongly correlated with ASD. Genome-wide mRNA, CpG methylation and miRNA were assayed with the Illumina Hiseq 2500, HTG EdgeSeq miRNA Whole Transcriptome Assay, and Illumina EPIC/850K array, respectively. We conducted genome-wide differential mRNA/miRNA and epigenome-wide placenta analyses. These molecular features were integrated for a predictive analysis of IQ and SRS outcomes using kernel aggregation regression. We lastly examined associations between ASD and the genomically-predicted component of IQ and SRS.ResultsGenes with important roles in placenta angiogenesis and neural function were associated with intellectual and social impairment. Kernel aggregations of placental multi-omics strongly predicted intellectual and social function, explaining approximately 8% and 12% of the variance in SRS and IQ scores via cross-validation, respectively. Predicted in-sample SRS and IQ showed significant positive and negative associations with ASD case-control status.LimitationsThe ELGAN is a cohort of children born pre-term, andgeneralization may be affected by unmeasured confounders associated with low gestational age. We conducted external validation of predictive models, though the sample size of the out-sample dataset (N = 49) and the scope of the available placental datasets are limited. Further validation of the models is merited.ConclusionsAggregating information from biomarkers within and between molecular data types improves prediction of complex traits like social and intellectual ability in children born extremely preterm, suggesting that traits influenced by the placenta-brain axis may be omnigenic.

scholarly journals Evidence for the placenta-brain axis: multi-omic kernel aggregation predicts intellectual and social impairment in children born extremely preterm

2020 ◽  
Vol 11 (1) ◽  
Author(s):  
Hudson P. Santos Jr ◽  
Arjun Bhattacharya ◽  
Robert M. Joseph ◽  
Lisa Smeester ◽  
Karl C. K. Kuban ◽  
...  
Keyword(s):  
Gestational Age ◽  
Social Function ◽  
Autism Spectrum ◽  
Cpg Methylation ◽  
Intellectual Ability ◽  
Social Impairment ◽  
Neurodevelopmental Outcomes ◽  
Tissue Organization ◽  
Genome Wide ◽  
Extremely Preterm

Abstract Background Children born extremely preterm are at heightened risk for intellectual and social impairment, including Autism Spectrum Disorder (ASD). There is increasing evidence for a key role of the placenta in prenatal developmental programming, suggesting that the placenta may, in part, contribute to origins of neurodevelopmental outcomes. Methods We examined associations between placental transcriptomic and epigenomic profiles and assessed their ability to predict intellectual and social impairment at age 10 years in 379 children from the Extremely Low Gestational Age Newborn (ELGAN) cohort. Assessment of intellectual ability (IQ) and social function was completed with the Differential Ability Scales-II and Social Responsiveness Scale (SRS), respectively. Examining IQ and SRS allows for studying ASD risk beyond the diagnostic criteria, as IQ and SRS are continuous measures strongly correlated with ASD. Genome-wide mRNA, CpG methylation and miRNA were assayeds with the Illumina Hiseq 2500, HTG EdgeSeq miRNA Whole Transcriptome Assay, and Illumina EPIC/850 K array, respectively. We conducted genome-wide differential analyses of placental mRNA, miRNA, and CpG methylation data. These molecular features were then integrated for a predictive analysis of IQ and SRS outcomes using kernel aggregation regression. We lastly examined associations between ASD and the multi-omic-predicted component of IQ and SRS. Results Genes with important roles in neurodevelopment and placental tissue organization were associated with intellectual and social impairment. Kernel aggregations of placental multi-omics strongly predicted intellectual and social function, explaining approximately 8% and 12% of variance in SRS and IQ scores via cross-validation, respectively. Predicted in-sample SRS and IQ showed significant positive and negative associations with ASD case–control status. Limitations The ELGAN cohort comprises children born pre-term, and generalization may be affected by unmeasured confounders associated with low gestational age. We conducted external validation of predictive models, though the sample size (N = 49) and the scope of the available out-sample placental dataset are limited. Further validation of the models is merited. Conclusions Aggregating information from biomarkers within and among molecular data types improves prediction of complex traits like social and intellectual ability in children born extremely preterm, suggesting that traits within the placenta-brain axis may be omnigenic.

Prevalence of Speech Problems and the Use of Augmentative and Alternative Communication in Children With Cerebral Palsy: A Registry-Based Study in Norway

2010 ◽  
Vol 19 (1) ◽  
pp. 12-20 ◽  
Author(s):  
Guro Andersen ◽  
Tone R. Mjøen ◽  
Torstein Vik
Keyword(s):  
Cerebral Palsy ◽  
Motor Function ◽  
Gestational Age ◽  
Augmentative And Alternative Communication ◽  
Alternative Communication ◽  
Gross Motor ◽  
Gross Motor Function ◽  
Children With Cerebral Palsy ◽  
Communicative Abilities ◽  
Normal Speech

Abstract This study describes the prevalence of speech problems and the use of augmentative and alternative communication (AAC) in children with cerebral palsy (CP) in Norway. Information on the communicative abilities of 564 children with CP born 1996–2003, recorded in the Norwegian CP Registry, was collected. A total of 270 children (48%) had normal speech, 90 (16%) had slightly indistinct speech, 52 (9%) had indistinct speech, 35 (6%) had very indistinct speech, 110 children (19%) had no speech, and 7 (1%) were unknown. Speech problems were most common in children with dyskinetic CP (92 %), in children with the most severe gross motor function impairments and among children being totally dependent on assistance in feeding or tube-fed children. A higher proportion of children born at term had speech problems when compared with children born before 32 weeks of gestational age 32 (p > 0.001). Among the 197 children with speech problems only, 106 (54%) used AAC in some form. Approximately 20% of children had no verbal speech, whereas ~15% had significant speech problems. Among children with either significant speech problems or no speech, only 54% used AAC in any form.

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