Extremely-low-birthweight infants: neurological, psychological, growth and health status beyond five years of age

Of 60 consecutive survivors of birth weight 500-999 g, who were born in one tertiary perinatal centre from 1977 to 1980, 59 infants were assessed by a multidisciplinary team at two years of age (corrected for prematurity) and 58 children were evaluated when aged at least five years. At the latter examination, 9% of the 58 children who were assessed were severely disabled; 17% had a mild or moderate disability; and 74% had no important disability. For the 53 children who were tested, the means for the three scales of the Wechsler Preschool and Primary Scales of Intelligence were just above the test mean. The psychologist noted behavioural problems during her assessment in 50% of children, and 29% of mothers reported behavioural problems which could interfere with schooling. At the age of five years and over, five (9%) children had cerebral palsy and one child was deaf. Twenty-two (38%) children had a visual impairment, although only one child was blind; the detection of retinopathy of prematurity in the nursery was an important risk factor. Health problems with readmissions to hospital and suboptimal growth were present in many children at two years of age and frequently these problems persisted to five years of age. Although only four (7%) children were too disabled to attend a normal school, apprehension exists that many of the other children may later encounter educational difficulties. At the two-years' assessment, ascertainment of cerebral palsy had not been complete or entirely accurate and the Mental Developmental Index of the Bayley Scale tended to underestimate the later psychological performance.     

Cognitive development of Yu-Cheng ("oil disease") children prenatally exposed to heat-degraded PCBs.

OBJECTIVE--To compare the cognitive development in Taiwanese children who had been exposed prenatally to high levels of heat-degraded polychlorinated biphenyls (PCBs) with control children who were exposed to background levels. The disorder was called Yu-Cheng, "oil disease," in Taiwan. DESIGN--Matched-pair cohort study. SETTING--Communities in central Taiwan in which there had been a cooking-oil contamination and mass poisoning by heat-degraded PCBs in 1978 through 1979. PARTICIPANTS--One hundred eighteen children born between June 1978 and March 1985 during or after their mothers' consumption of contaminated rice oil; 118 children matched for age, sex, neighborhood, maternal age, and parental education and occupational class; and 15 older siblings of exposed children, born before the poisoning. MAIN OUTCOME MEASURES--Cognitive development measured from 1985 through 1990 using the Chinese versions of the Stanford-Binet test and the Wechsler Intelligence Scale for Children, Revised, RESULTS--The exposed children scored approximately 5 points lower on the Stanford-Binet test at the ages of 4 and 5 years and approximately 5 points lower on the Wechsler Intelligence Scale for Children, Revised, at the ages of 6 and 7 years. Children born up to 6 years after their mothers' exposure were as affected as children born within a year or two after exposure when examined at 6 and 7 years of age. Older siblings resembled the control children. CONCLUSION--Children prenatally exposed to heat-degraded PCBs had poorer cognitive development than their matched controls. The effect persisted in the children up to the age of 7 years, and children born long after the exposure were still affected.     

Very low birthweight and normal birthweight infants. A comparison of continuing morbidity

One hundred and forty-eight (95.5%) of 155 consecutive two-year survivors of 227 very low birthweight (VLBW, less than 1501 g) infants and 50 (83.3%) of 60 infants of normal birthweight who were selected at random, all of whom were born at the Royal Women's Hospital, Melbourne from October 1980 to March 1982, were seen at the age of two years. Social, psychological and health data were compared between the groups. The mean Bayley Mental Developmental Index scores of VLBW children were significantly lower; the prevalence of major handicaps and poor growth (height and weight below the 10th percentile), and the number of hospital readmissions, wheezing episodes, major and minor congenital anomalies and postnatally-acquired malformations (for example, abnormally shaped skull) were significantly greater in VLBW children. There was a trend for a greater number of episodes of otitis media, lower respiratory tract infections and surgical procedures per child in VLBW children. Extremely low birthweight children (birthweight less than 1000 g) contributed significantly to this morbidity. Parents of VLBW children perceived significantly more problems with infant vomiting and behavioural disturbances at two years of age. The children of mothers of limited education, or immigrant status and non-fee paying or lower socioeconomic families had lower mean Bayley Mental Developmental Index scores but similar handicap rates and health status in both weight cohorts.     

A study of five year old children born after elective induction of labour

A controlled retrospective study of some short-term and long-term effects of elective induction of labour was conducted. There did not appear to be any increase in the incidence of maternal complications during labour, or of neonatal problems in the induced-labour group compared with the remainder of the mothers in the hospital. In the follow-up phase of the study, two treatment groups of children who were delivered after amniotomy and amniotomy plus the administration of oxytocin were compared with each other, and with a control group of children born after spontaneous labour. The children were assessed at the age of five years on verbal and non-verbal subtests of a standardized intelligence scale, tests of gross motor and fine motor coordination, and auditory and visual tests. A full physical examination was also performed. No statistically significant differences nor trends of clinical interest were found between the groups on any measure.     

The health and developmental status of very low-birth-weight children at school age.

OBJECTIVE--To assess the effect of improved survival of increasingly premature infants by examining the outcomes at school age of a large group of children born at different birth weights. DESIGN--Inception cohort. SETTING/PARTICIPANTS--Participants were selected from two previously studied multisite cohorts: very low-birth-weight (less than or equal to 1500 g) children referred to participating intensive care units and heavier birth-weight children drawn from a stratified random sample of births in geographically defined regions. Follow-up at 8 to 10 years of age was by a combination of telephone interview and home/clinic visits for 65.1% (1868) of those eligible. MAIN OUTCOME MEASURES--The presence or absence of 17 specific conditions, limitations in activities of daily living due to health, mental health (affective health, behavior problems), and, for a subset, IQ scores. RESULTS--Decreasing birth weight was associated with an increased morbidity for all measures except affective health; those with birth weights of 1500 g or less were more likely to experience multiple health problems. Maternal educational attainment did not influence the association of birth weight with morbidity except for IQ among children whose birth weight was above 1000 g, for which socioeconomic disadvantage worsened the status of all children irrespective of birth weight. CONCLUSIONS--Children born at lower birth weights experience increased morbidity at early school age. These results reinforce the importance of postdischarge, early intervention programs to reduce the risk of these later health problems.     

Malformations in infants of very low birth weight

The incidence of lethal, serious and trivial malformations was determined in a consecutive series of 675 infants who weightd 1500 g or less (very low birth weight infants). All patients were born in one maternity hospital. Most of the 169 survivors were followed until at least five years of age. Of these children, 15 had a trivial malformation that either disappeared spontaneously or was corrected surgically. A further five children have a significant or serious residual defect. There were 506 perinatal and infant deaths and 51 of the babies who died had malformations confirmed at necropsy. In 30 of these, death was inevitable. There were 10 seriously malformed infants for whom survival was possible, but in six cases, the diagnosis was obvious at birth. The patients were treated between 1966 and 1970 when techniques of intensive care were evolving. Consequently, some of the infants who died would have survived with the treatment now available. Amongst the perinatal deaths in this report, only 2.0% had a serious malformation compatible with survival.     

Adult functional outcome of those born small for gestational age: twenty-six-year follow-up of the 1970 British Birth Cohort

CONTEXT: Although studies have documented cognitive impairment in children who were born small for gestational age (SGA), other studies have not demonstrated differences in IQ or other cognitive scores. The need exists for long-term studies of such children to assess functional outcomes not measurable with standardized testing. OBJECTIVE: To determine the long-term functional outcome of SGA infants. DESIGN: Prospective cohort study. SETTING AND PARTICIPANTS: A total of 14,189 full-term infants born in the United Kingdom on April 5 through 11, 1970, were studied as part of the 1970 British Birth Cohort; 1064 were SGA (birth weight less than the fifth percentile for age at term). Follow-up at 5, 10, 16, and 26 years was 93%, 80%, 72%, and 53%, respectively. MAIN OUTCOME MEASURES: School performance and achievement, assessed at 5, 10, and 16 years; and years of education, occupational status, income, marital status, life satisfaction, disability, and height, assessed at 26 years, comparing persons born SGA with those who were not. RESULTS: At 5, 10, and 16 years of age, those born SGA demonstrated small but significant deficits in academic achievement. In addition, teachers were less likely to rate those born SGA in the top 15th percentile of the class at 16 years (13% vs 20%; P<.01) and more likely to recommend special education (4.9% vs 2.3%; P<.01) compared with those born at normal birth weight (NBW). At age 26 years, adults who were SGA did not demonstrate any differences in years of education, employment, hours of work per week, marital status, or satisfaction with life. However, adults who were SGA were less likely to have professional or managerial jobs (8.7% vs 16.4%; P<.01) and reported significantly lower levels of weekly income (mean [SD], 185 [91] vs 206 [102] pound sterling; P<.01) than adults who were NBW. Adults who were SGA also reported significant height deficits compared with those who were NBW (mean [SD] z score, -0.55 [0.98] vs 0.08 [1.02]; P<.001). Similar results were also obtained after adjusting for social class, sex, region of birth, and the presence of fetal or neonatal distress. CONCLUSIONS: In this cohort, adults who were born SGA had significant differences in academic achievement and professional attainment compared with adults who were NBW. However, there were no long-term social or emotional consequences of being SGA: these adults were as likely to be employed, married, and satisfied with life.     

Age of death and duration in Huntington's disease in Tasmania

The records of all Huntington's disease affected individuals born in Tasmania were examined. An age of birth exclusion criterion (only those born before 1928 were accepted) removed some bias in the determination of duration of illness and age of death. The mean age of death was at least 62.9 years. This is the oldest mean age of death reported for any geographical region. The sex of the affected individual and the sex of the transmitting parent did not significantly influence the mean age of death. The children of affected women lived to a greater age than theri mothers and the children of affected men died at a younger age than their fathers, but statistical significance was not achieved. The duration of the disease was 14.8 years.     

Longitudinal study of obesity in the National Survey of Health and Development

In a nationally representative cohort of 5362 children born in one week in March 1946 weights and heights were recorded at 6, 7, 11, 14, 20, and 26 years. Overweight was defined as a weight that exceeded the standard weight for height, age, and sex by more than 20% (relative weight greater than 120%). The prevalence of overweight was 1.7% and 2.9% in boys and girls respectively at 6 years; 2.0% and 3.8% at 7 years; 6.4% and 9.6% at 11 years; 6.5% and 9.6% at 14 years; 5.4% and 6.5% at 20 years; and 12.3% and 11.2% at 26 years. The risk of being overweight in adulthood was related to the degree of overweight in childhood and was about four in 10 for overweight 7-year-olds. Analysis of the data in the reverse direction showed that 7% and 13% respectively of 26-year-old overweight men and women had been overweight at the age of 7. These results suggest that there is no optimal age during childhood for the prediction of overweight in adult life and that excessive weight gain may begin at any time. Overweight children are more likely to remain overweight than their contemporaries of normal weight are to become overweight.     

推行独生子女政策前与后出生的独生子女间个性对照研究

目的调查推行独生子女政策之前与之后出生的独生子女之间有无个性差异.方法研究组为推行独生子女政策前出生的、1987年调查时已达到16～18岁城市高中部的独生子女;抽样方法:逐班统计出合肥市10所市属高中内的全部独生子女.对照组为推行独生子女政策后出生的、1998年调查时已达到16～18岁城市高中部的独生子女.抽样方法:从上述高中高二和高三年级中,按"逢十抽一"的原则抽样;以MMPI为测试工具.研究组最后共有156名独生子女人组(男87名,女69名);对照组最后有192名独生子女人组(男性114名,女性78名);两组间父、母平均年龄、学历基本相同.结果男生研究组较之对照组表现为MMPI量表中F、Pa、Sc等3个量表高分,K量表低分.女生研究组较之对照组表现为MMPI量表中F、Sc、Ma等3个量表高分.结论推行独生子女政策之前与之后出生的独生子女之间有一定程度的个性差异.     

Asthma and atopic disease in immigrants from Asia and the West Indies

The clinical pattern of asthma and atopic disease was compared in 2331 children of European, Asian and West Indian parentage seen in Birmingham in the past 10 years. The main findings were that a higher proportion of children born in England of all races developed asthma within the first 4 years of life than children born abroad; the sex ratio of roughly 2 boys to every girl with asthma was similar in each race wherever born; the ratio of persistent to intermittent asthma was similar in each race wherever born; there was no difference in the proportion with eczema between the racial groups; hay fever and pollen allergy was less frequent in Asian and West Indian children even if born in England; hospital admission was more frequent in immigrant groups; positive skin reactions to grass pollen and domestic animals were more frequent in European children than in immigrants but positive reactions to house-dust mites were less frequent in European children.     

Clinical utility of HIV-IgA immunoblot assay in the early diagnosis of perinatal HIV infection.

OBJECTIVE--To ascertain the sensitivity, specificity, predictive value, and clinical use of a human immunodeficiency virus (HIV)-IgA immunoblot assay for diagnosing perinatal HIV infection in infants tested at birth to 1 month, 3 months, and 6 months of age. DESIGN--Prospective, longitudinal cohort study of children born to HIV-infected and noninfected women. The HIV-IgA immunoblot assays were performed at birth to 1 month, 3 months, and 6 months of age and compared with the Centers for Disease Control's classification system of HIV infection in the children. Children were followed up for at least 15 months to ensure accuracy of infection status. SETTING--Municipal hospital in central Brooklyn, NY, where the prevalence of HIV infection is high. PATIENTS--Serum samples from 58 children, 22 with documented HIV infection, 18 noninfected children born to seropositive women, and 18 children born to noninfected women, were studied. MAIN OUTCOME MEASURE--Diagnosis of HIV infection using the Centers for Disease Control's classification scheme was compared with diagnosis using the HIV-IgA immunoblot assay for children 6 months of age or younger. RESULTS--The HIV-IgA immunoblot assay yielded negative results at 3 and 6 months of age for all 18 infants born to seronegative women; for the 18 seroreverting, noninfected children born to infected women, the assay yielded negative results at 1 month, 3 months, and 6 months of age. The positive predictive value of the assay was 100%--no false-positive results were identified in the 88 serum samples obtained from noninfected infants. For the HIV-infected children, sensitivity was a function of age: one (5.9%) of 17 infants had an assay that yielded positive results at birth to 1 month of age, 13 (62%) of 21 infants had assays that yielded positive results at 3 months of age, and 17 (77%) of 22 infants had assays that yielded positive results at 6 months of age. The presence or absence of symptoms did not affect the sensitivity. CONCLUSION--The HIV-IgA immunoblot assay can detect a significant proportion of infected children during an early asymptomatic period of their life. This relatively inexpensive, easily standardized assay may allow for institution of therapy before the onset of clinical symptoms.     

Sociodemographic and behavioural determinants of blood lead concentrations in children aged 11-13 years. The Port Pirie Cohort Study

OBJECTIVE: To describe the determinants of blood lead concentration in children with long term environmental exposure to lead. DESIGN: Prospective cohort study. SETTING: The lead smelting town of Port Pirie, South Australia, and surrounding townships. PARTICIPANTS: 326 children born in and around Port Pirie, 1979-1982, followed up until age 11-13 years in 1993-1994. MAIN OUTCOME MEASURES: Blood lead concentrations assessed at birth and at multiple ages up to 11-13 years; average lifetime blood lead concentration. RESULTS: Mean blood lead concentration rose sharply over the ages 6 to 15 months, reached a maximum around 2 years of age, and declined steadily as the children grew older. There was no difference in blood lead concentration between boys and girls until they reached the age of 11-13 years, when mean blood lead concentration in boys (8.4 micrograms/dL [0.41 mumol/L]) was slightly higher than in girls (7.5 micrograms/dL [0.36 mumol/L]). Residential area and father's employment site were the two variables most strongly predictive of a child's blood lead concentration at the end of primary school. Poorer-quality home environment was also found to be an independent contributor to blood lead concentrations. CONCLUSIONS: Age-related factors, and possibly recent concerted efforts to decrease entry or re-entrainment of lead into the environment at Port Pirie, have resulted in most children in our study having blood lead concentrations below 10 micrograms/dL (0.48 mumol/L) at the end of their primary school years. Lead exposure during a child's early years remains an important contributor to average lifetime exposure.     

Age of onset of Huntington's disease in Tasmania

Various aspects of the age of onset of Huntington's disease (HD) were studied using extensive Tasmanian data. The mean age of onset of those born before 1930 was determined. For the total Tasmanian population of HD sufferers, this was 48.3 years. This finding has clinical implications because the most dangerous period for "at risk" individuals is frequently stated to be between 20 and 45 years. The range of age of onset for one very large Tasmanian family (the "Brothers family") is 53 years, from the second to the seventh decade. There were no juvenile-onset cases (onset before 20 years of age) in patients born in Tasmania before 1930. Three juvenile cases have occurred in those born since 1930. Support was found for the observation of paternal transmission in juvenile-onset HD. No support was found for the observation of maternal transmission in late-onset disease (50 years and beyond).     

Prevalence of antibodies to poliovirus in 1978 among subjects aged 0-88 years

The antibody state of a population aged 6 months to 88 years to poliovirus types 1, 2, and 3 was determined by examining 919 sera collected in Lancashire, London, and southern and south-east England. In subjects aged over 2 years the immune state was surprisingly uniform, although the older patients had probably acquired practically all their antibodies as a result of natural infection and those under 16 through vaccination. at least 95% had detectable antibodies to at least one poliovirus type and about 60% to all three types, with the exception of a cohort of children born between 1963 and 1968, in whom the proportions were about 80% and 40% respectively. These children were born around the time of the changeover from inactivated to oral vaccine, when immunisation rates were low and there was confusion over the number of doses required. These results indicate that a complete course of vaccine or a booster dose at or around school-leaving age is necessary.     

DPOA对不同胎龄高胆红素血症早产儿听力的筛查研究

目的：观察高胆红素血症时不同胎龄早产儿听力的影响,探讨畸变产物耳声发射（DPOAE）检测技术对高胆红素血症早产儿听力筛查的意义。方法：对2011年1月至2012年12月沈阳市妇婴医院收治的256例不同胎龄的高胆红素血症早产儿（高胆红素血症组）及363例不同胎龄的血清总胆红素正常的早产儿（对照组）进行I）POAE测试,未通过者出生后42d后复查．仍不能通过者于出生后3个月再次复查并行脑干诱发电位检查,结果：高胆红素血症组DPOAE初筛总通过率、复筛总通过率、第三次筛查总通过率及脑千诱发电位检查异常率与对照组相比,差异均有统计学意义（P〈0．05）,高胆红素血症组中不同胎龄早产儿脑干诱发电位检查异常率比较,差异有统计学意义（P〈0．05）。结论：高胆红素血症可引起早产儿听力障碍,胎龄越小影响越明显;DPOAE可作为筛查高胆红素血症早产儿听力障碍的基苯方法。     

4659例新生儿出生体重的调查分析

本文通过4695例新生儿出生体重调查,提示了一个地区新生儿出生体重的分布情况,出生体重均值男婴3.31±0.48公斤,女婴3.22±0.46公斤,男女间差异有显著意义,略高于全国九城市及有关地区调查结果。新生儿出生体重在前三胎有随胎次增加的倾向。第四胎有所下降但与第三胎差异无显著意义。母亲的分娩年龄<25岁及>40岁年龄组者,新生儿出生体重<2.5公斤及2.5公斤组的比例较大,而3.5公斤以上者比例较小,与有关报道一致。本资料反映了该地区普通居民新生儿出生体重水平,具有一定的代表性,对妇幼保健及计划生育工作有一定参考价值。     

Intestinal parasites in metropolitan Toronto day-care centres.

In 1981, 900 children (aged 3 months to 10 years) and 146 staff attending 22 day-care centres in metropolitan Toronto chosen at random provided a stool specimen in a survey for intestinal parasites. Of the children, 4% to 36% were infected in 20 of 22 centres. Overall, 19% of the children and 14% of the staff had intestinal parasites: 8.6% and 4.0% respectively had Dientamoeba fragilis, and 7.8% and 2.0% respectively had Giardia lamblia. The highest prevalence of dientamebiasis was in the 7- to 10-year-olds, whereas giardiasis was detected most frequently in the 6-year-olds. Infection with intestinal parasites was not correlated with age, sex, duration in the day-care centre, dog ownership, travel history, gastrointestinal symptoms or the proportion of children in the day-care centre who were born in less developed countries. Immigrant children and children of parents born in industrialized countries (including Canada) were more likely to be infected than were children born in Canada of parents from the developing world. Dientamebiasis was associated with cat ownership. Thus, intestinal protozoa--in particular, D. fragilis and G. lamblia--are endemic in Toronto day-care centres.     

Some perinatal risk factors in a developing country

Mothers attending the antenatal clinic and the under-5 clinic at Katangi Dispensary in rural Kenya were carefully interviewed about their obstetrical history to elucidate the importance of certain obstetrical risk factors. Women with suspected twins and women with previous perinatal deaths were found to constitute high risk groups. Perinatal mortality was found to be higher for all children born after a short birth interval than for children born after an interval of more than 3 years. The parity and age of the mother did not have any influence on the perinatal mortality. As the perinatal mortality was found to be high as in many other developing to hospitals for delivery and to follow up all women at risk carefully. The majority of women still give birth at home, a reason for which local clinics should be giving instructions at the antenatal in safer performance of deliveries and in proper umbilical cord care.     

Follow-up of children born after intracytoplasmic sperm injection with epididymal and testicular spermatozoa

Background To evaluate the safety of intracytoplasmic sperm injection (ICSI) with epididymal or testicular sperm,this study compared children born after ICSI treatment with epididymal or testicular spe...