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Problems in behavioural and emotional outcome are amongst the long-term sequelae of preterm birth. The exact prevalence and associations with perinatal risk factors are unknown. Minimal research has been performed in pre-school aged children, compared to school age. The primary aim of this study was to determine the prevalence of parent-reported behavioural and emotional problems at the age of two in children born at less than 30 weeks' gestational age and/or birth weight less than 1000 g. The secondary aim was to determine whether perinatal factors were associated with the behavioural and emotional outcome.Perinatal characteristics of 144 preterm-born children from the NeoLiFeS cohort were collected retrospectively. Of these children, 101 parents filled out a Childs Behaviour Checklist (CBCL) at the corrected age of two. The results of the CBCL tests were presented as Z-scores, a Z-score of 0 indicating the mean of behavioural scores in the norm population. A Z-score higher than zero indicates less behavioural problems than average, a negative Z-score indicates more problems. Associations between perinatal risk factors and CBCL-scores were analysed using linear regression analyses.Prevalences of clinically relevant CBCL scores were low, 4%, 2% and 5% for total score, internalizing score or externalizing score, respectively. Being part of a twin was associated with higher internalizing Z-scores, indicating less problems in emotional behaviour. Bronchopulmonary dysplasia was associated with lower Z-scores in total and externalizing behaviour. In conclusion, in our cohort generally very few problems in behavioural and emotional outcome were reported at the age of two.

BACKGROUND: Accurate prediction of persistent and emerging developmental problems in preterm-born children may lead to targeted interventions.AIMS: To determine whether specific perinatal and social factors were associated with persistent, emerging, and resolving developmental problems of early-preterm (EPs) and moderately-and-late-preterm children (MLPs) from before to after school entry.STUDY DESIGN: Observational longitudinal cohort study, part of the LOLLIPOP cohort-study.SUBJECTS: 341 EPs and 565 MLPs.OUTCOME MEASURES: Developmental problems using the Ages and Stages Questionnaire at ages 4 and 5. We collected data on perinatal and social factors from medical records. Using logistic regression analyses we assessed associations between 48 factors and persistent, emerging, and resolving problems.RESULTS: Of EPs, 8.7% had persistent and 5.1% emerging problems; this was 4.3% and 1.9% for MLPs, respectively. Predictors for persistent problems included chronic mental illness of the mother, odds ratio (95% confidence interval) 8.01 (1.85-34.60), male sex 4.96 (2.28-10.82), being born small-for-gestational age (SGA) 2.39 (1.15-4.99), and multiparity 3.56 (1.87-6.76). Predictors for emerging problems included MLP birth with prolonged premature rupture of membranes (PPROM) 5.01 (1.38-18.14). Including all predictors in a single prediction model, the explained variance (Nagelkerke R2) was 21.9%, whereas this was 3.0% with only EP/MLP birth as predictor.CONCLUSIONS: Only few perinatal and social factors had associations with persistent and emerging developmental problems for both EPs and MLPs. For children with specific neonatal conditions such as SGA, and PPROM in MLPs, problems may persist. Insight in risk factors largely improved the prediction of developmental problems among preterm children.

Background: Selective serotonin reuptake inhibitors (SSRIs) are prescribed in 2-8% during pregnancy. Whether prenatal exposure to SSRIs has long-term effects on the children's development is unknown.Aim: The aim of this study was to determine the effect of prenatal exposure to SSRIs on children's cognitive, motor, and behavioral outcomes at 2.5 years, adjusted for maternal depression and anxiety.Methods: In a prospective, longitudinal cohort-study we included 111 pregnant women treated either or not with an SSRI. We examined cognitive and motor development of their children at 2.5 years, using the Bayley Scale of Infant and Toddler Development, 3rd Edition, and measured emotional and behavioral problems using the parent-rated Child Behavior Checklist (CBCL). Maternal depression and anxiety was determined during pregnancy and at the children's assessment. Differences of normed cognitive, motor, and behavioral scores between SSRI-exposed and non-SSRI-exposed children were tested using multiple linear regression analyses.Results: We examined 102 children. SSRI-exposed children had lower scaled scores on cognition and gross motor development than non-SSRI-exposed children: 9.0 +/- 1.4 (mean +/- SD) versus 9.9 +/- 1.7 [P = 0.004], and 7.9 +/- 2.2 versus 9.0 +/- 2.5 [P = 0.01], respectively. Differences remained significant after adjusting for maternal depression and anxiety and other confounders in various models (mean difference for cognition 0.8 to 0.9 points, for gross motor 1.1 to 1.2 points). Only after adjusting for severity of maternal anxiety, differences in gross motor scores lost significance.Conclusions: Prenatal exposure to SSRIs is associated with poorer cognitive and gross motor development of the children at 2.5 years. Effects on gross motor development disappeared after correction for severity of maternal anxiety.

BACKGROUND: Surviving preterm born children, postnatally exposed to high doses of dexamethasone, show an increased risk of neurodevelopmental impairments. Regarding treatment with low doses of dexamethasone, no data exist on outcomes at school age.AIM: To assess the functional outcome at school age of preterm-born children treated with low-dose dexamethasone.STUDY DESIGN: In this cohort study, twenty-seven very preterm-born infants treated with dexamethasone from eight days after birth, underwent neuropsychological assessments at age 6-13 years. Their scores were compared with those of the norm population, and scores on total IQ and motor functioning also with those of a preterm reference group, using one-sample-chi-square and student's t-tests.RESULTS: Compared with the norm population, performance of dexamethasone-treated children was poorer, particularly in the motor domain (mean z-score - 1.81). Dexamethasone-treated children also had lower scores on IQ (-0.29 to -1.12), verbal memory (-0.41 to -0.56), attention (-0.90 to -1.28), and word generation (-0.75). Their parents reported behavioral problems more often. Compared with preterm peers, motor skills remained poor, but total IQs were similar. Adjustment for bronchopulmonary dysplasia did not change our results, because all surviving children had bronchopulmonary dysplasia.CONCLUSIONS: At school age, the prevalence of adverse motor, cognitive, and behavioral outcomes of preterm-born children treated with low-dose dexamethasone is increased. This could be the consequence of either dexamethasone or BPD.

BACKGROUND: Little is known on the motor development of moderately preterm born (MPT) children, in comparison with early preterm born (EPT) children and fullterm born (FT), for children with normal motor outcomes at school entry.AIMS: To compare attainment rates of gross motor milestones reached between ages 1-24 months for MPT, EPT, and FT children, all with normal development upon school entry.STUDY DESIGN: Prospective cohort study.SUBJECTS: We included 1247 preterm (PT) children (gestational age [GA] 24.0-35.6 weeks) and 488 FT children (GA 38.0-41.6 weeks), with normal gross motor development at 4 years according to the Ages and Stages Questionnaire.OUTCOME MEASURES: We assessed 11 gross motor milestones assessed in preventive child healthcare during six standardized visits at calendar age.RESULTS: During the first six months, all PT categories had lower milestone attainment-rates than FTs children (differences 9-60% for PTs compared with FTs children). For all PT categories attainment rates gradually increased during toddlerhood. For PT children with higher GA, differences in attainment rates compared with FTs children were smaller and attainment rates became comparable to FT children at an earlier age. At age 24 months only attainment rates for PT children born CONCLUSION: Milestone attainment rates are highly dependent on GA during the first two years. Differences between PT and FT children are larger and persist longer with lower GA. For PT children

BACKGROUND: Preterm infants requiring surgery are at risk of impaired neurocognitive development caused, possibly, by cerebral ischemia associated with impaired cerebrovascular autoregulation (CAR). We evaluated CAR before, during, and after laparotomy.STUDY DESIGN: This was a hypothesis generating prospective observational cohort study.SUBJECTS: We included preterm infants requiring surgery for necrotizing enterocolitis (NEC) or spontaneous intestinal perforation (SIP). Before, during, and after surgery we measured cerebral oxygen saturation using NIRS and calculated cerebral fractional tissue oxygen extraction (cFTOE).OUTCOME MEASURES: Impaired CAR was defined if correlation coefficients (rho) between mean cFTOE and mean arterial blood pressure values were ≤-0.30 with P RESULTS: Nineteen infants with median (IQR) GA 27.6 weeks (26.6-31.0), birth weight 1090 g (924-1430), and postnatal age 9 days (7-12) were included. CAR was impaired more often during surgery than before (12 versus 3, P = .02) or after (12 versus 0, P CONCLUSIONS: More than half of preterm infants with NEC or SIP displayed evidence of impaired CAR during laparotomy. Further research should focus on mechanisms contributing to impaired CAR in preterm infants during surgery.

Background Evidence suggests that hypoxic-ischemic brain injury in infants with congenital heart disease already occurs during early life. The aim of our study was, therefore, to assess the course of regional cerebral oxygen saturation (r c SO 2 ) and fractional tissue oxygen extraction (FTOE) during the first 72h after birth in infants with prenatally diagnosed duct-dependent congenital heart disease. In addition, we identified clinical parameters that were associated with r c SO 2 . Materials and methods We included 56 infants with duct-dependent congenital heart disease. We measured arterial oxygen saturation (SpO 2 ) and r c SO 2 during the first 72h after birth. Simultaneously, we calculated FTOE. Results We observed median r c SO 2 values of approximately 60%, a decreasing FTOE from 0.34 on day 1 to 0.28 on day 3 and stable preductal SpO 2 values around 90%. Several clinical variables were associated with r c SO 2 . In a multiple linear regression model only type of CHD and preductal SpO 2 were significant predictors of r c SO 2 during the first three days after birth. Infants with a duct-dependent pulmonary circulation had up to 12% lower r c SO 2 values than infants with a duct-dependent systemic circulation. Conclusion We demonstrated that, during the first three days after birth, cerebral oxygen saturation is low in infants with duct-dependent congenital heart disease. Furthermore, this study provides preoperative reference values of r c SO 2 and FTOE in infants with duct-dependent CHD.

Background: Specific knowledge about the functional outcome of preterm born children with post-hemorrhagic ventricular dilatation (PHVD) is lacking.Objectives: To determine functional outcome at school age in children with post-hemorrhagic ventricular dilatation and to identify whether PHVD characteristics increased the risk for deficits.Methods: Single-center case-control study. Included were preterm children born between 1996 and 2003 who had PHVD in their neonatal period. The controls were children matched for gestation, gender, and year of birth. At school age, using standardized tests and questionnaires, we assessed intelligence, attention, verbal memory, executive functioning, visual perception, visuomotor integration, motor skills, and behavior.Results: Of 34 children with PHVD 28 survived, three of whom could not be tested at school age (one child's parents declined and two were lost to follow-up). At a mean age of 10 years (6-14 years) the total and verbal IQs of the remaining 25 children (17 boys, 8 girls) were significantly lower compared to controls (difference in total IQ-14 points, verbal IQ-9 points, P = 0.001and P = 0.009, respectively). After adjustment for possible confounders, the performance of the PHVD group was poorer on visual perception and attention tests. Selective attention showed a trend toward risk of borderline and abnormal scores (OR 4.03, 95%-CI 0.84-19.2). Within the PHVD group, total IQ was significantly lower (P = 0.048) in those who had undergone surgical intervention (n = 12).Conclusion: At school age, intelligence, attention, and visual perception were more affected in the PHVD group than in the matched controls. Surgical intervention was associated with lower IQ scores. (C) 2016 Elsevier Ireland Ltd. All rights reserved.

Contains fulltext : 139791.pdf (Publisher’s version ) (Closed access) Background: During early infancy major developmental changes, both in the variety of body movements and in visual attention, help the infant to explore its surroundings. Both behaviours depend on a gradual shift from subcortical to cortical functioning. Aims: First, to determine whether preterms reach mature levels of movement variety (the number of different movement patterns) and visual attention earlier than fullterms. Second, to determine whether individual developmental trajectories of movement variety and visual attention were associated. Finally, we compared the associations of developmental trajectories between fullterm and preterm infants. Study design: In this longitudinal study, 20 fullterm and 9 low-risk preterm infants performed a visual disengagement task every four weeks from six weeks until six months postterm. For each infant we drew up developmental trajectories for movement variety, and for frequencies and latencies of looks. We analyzed the developmental trajectories by means of general linear model (GLM) repeated measures and Monte Carlo analyses. Results: In comparison to fullterms, preterm infants showed a similar increase in movement variety over time (F(4,108) = 0.27; partial eta(2) = 0.01; P = .90). Visual attention reached mature levels four weeks earlier than movement variety. This effect was stronger in fullterm infants. Neither in fullterm nor in preterm infants did we find an association between the developmental trajectories of movement variety and visual attention. P values ranged from .37 to .99. Conclusions: During the first 6 months postterm, movement variety and visual attention developed independently. Temporarily, preterm exposure to the extrauterine environment led to shorter latencies of looks but it did not affect developmental trajectories of frequencies of looks and movement variety. 8 p.

Postnatal dexamethasone (DXM) treatment is associated with adverse motor outcome. It is largely unknown as to what extent functional outcome at school age is affected.Our first aim was to determine motor, cognitive, and behavioural outcome at school age of preterm-born children treated with high-dose DXM for pulmonary problems. Our second aim was to identify DXM-related risk factors for adverse outcome.In this cohort study, we included 53 very preterm-born children treated with DXM (starting dose 0.5mg/kg/d) after the first week of life. At the median age of 9 years, we performed a detailed neuropsychological assessment.Compared to the norm population, DXM-treated children scored worse on the Movement-ABC (abnormal fine motor, ball skills and balance: 59%, 47% and 30%, respectively). They more often had total (36%), verbal (32%) and performance IQs (55%) below 85 (P.001, P=.002, P.001, respectively). On each of the remaining measures, DXM-treated children scored worse than the norm population, except for verbal long-term memory and verbal recognition memory. DXM-related risk factors were associated with poorer performance.At school age, multiple domains of functional outcome were affected in DXM-treated children. Risk factors related to the use of DXM should be considered as serious potentiaters of adverse outcome in children treated with high-dose DXM.

Background: The quality of general movements (GMs) is a widely used criterion to assess neurological dysfunction in young infants. It is unknown, however, whether the birth process influences the motor repertoire of healthy full term infants during the first week after birth.Aims: To assess the quality of GMs and to determine the motor optimality score (OS) in healthy full term infants during the first week after birth and to evaluate the influence of the mode of delivery on GM quality.Study design: Thirty-three healthy full term infants born either vaginally or after caesarean section (CS) under spinal anaesthesia were video recorded in the first week after birth in order to assess GM quality and to determine OS with Prechtl's method.Results: Abnormal GMs were observed mainly on the early recordings: 86% on the day of birth (day 0), 94% on day 1, and 68% on day 2. On days 5 to 7 (day 5-7) all GMs were normal (P Conclusions: Healthy full term infants often showed abnormal GM quality and lower OSs during the first week after birth, irrespective of the mode of delivery. GM quality normalised during subsequent days and was normal on day 5-7. (C) 2013 Elsevier Ireland Ltd. All rights reserved.

The motor and cognitive outcome at school age of newborn children with surgically treated intestinal obstructions is unknown. Physiological stress and anesthesia may potentially be harmful in the period of early brain development in newborn infants.To determine motor and cognitive outcome at school age in children with surgically treated intestinal obstructions as newborns, and to identify clinical risk factors for adverse outcome.Cohort study of infants born between 1995 and 2002 with atresia, stenosis, or intestinal malrotation. At 6 to 13years we assessed their motor functions, intelligence, attention, visual perception, visuomotor integration, and verbal memory.Of 44 children three (7%) died. Twenty-seven survivors (66%) were included for follow-up (median gestational age 36.7weeks, birth weight 3000g). Motor outcome was abnormal (5th percentile) in 22% of the children, which was significantly more than in the norm population (P0.01). Scores on selective attention were abnormal in 15% of the children (P0.01). Other cognitive functions were not affected. Lower birth weight and intestinal perforation were risk factors for poorer motor outcome (R(2)=53.0%), intrauterine growth restriction was a risk factor for poorer selective attention (R(2)=36.6%).Children treated surgically for intestinal obstructions in the neonatal period had an increased risk for poor motor functioning and selective attention at school age. Low birth weight, intrauterine growth restriction and intestinal perforation were risk factors for adverse outcome. We recommend to closely follow the motor and attentional development of these children.

Background: The long-term effect of early intervention in infants at risk for developmental disorders is unclear. The VIP project (n = 46, originally) evaluated by means of a randomised controlled trial the effect of the family centred early intervention programme COPCA (Coping with and Caring for infants with special needs) in comparison to that of traditional infant physiotherapy (TIP).Aims: To evaluate the effect of early intervention on functional outcome at school age.Methods and procedures: Parents of 40 children (median age 83 years) participated in this follow-up study. Outcome was assessed with a standardised parental interview (Vineland Adaptive Behaviour Scale) and questionnaires (Developmental Coordination Disorder Questionnaire, Child Behaviour Checklist, Utrechtse Coping List, and questions on educational approach). Quantified video information on physiotherapeutic actions during infancy was available.Outcomes and results: Child functional outcome in the two randomised groups was similar. Process evaluation revealed that some physiotherapeutic actions were associated with child mobility and parental educational approach at follow-up: e.g., training and instructing were associated with worse mobility.Conclusions and implications: Functional outcome at school age after early intervention with COPCA is similar to that after TIP. However, some specific physiotherapeutic actions, in particular the physiotherapist's approach, are associated with outcome.What this paper adds: Early intervention is generally applied in infants at risk for developing disorders, with the aim of improving overall functional outcome. However, little is known on the long-term effect. The VIP project evaluated by means of a randomised controlled trial the effect of the family centred early intervention programme COPCA (Coping with and Caring for infants with special needs) in comparison to that of traditional infant physical therapy (TIP). Outcome at 18 months corrected age was virtually similar. Process evaluation of the physiotherapy actions revealed that some characteristics of COPCA were associated with improved developmental outcome at 18 months. This paper presents data on functional outcome at school age (median 83 years) in 87% of the original participants. Outcome of infants who received three months of COPCA and that of infants who received three months of TIP was similar. Yet, parents of families who had received the COPCA intervention still more often used a trial and error approach when the child learned a new skill than parents of children who had received TIP. Process evaluation showed that more time spent on caregiver training and strict instructions during early intervention was associated with worse mobility. Four other physiotherapeutic actions were associated with parental educational approach. None of the neuromotor actions were associated with child outcome at school age.We conclude that long-term outcome after three months of COPCA or TIP is similar. However, our study does suggest that the professional approach of the physiotherapist can make a difference. (C) 2017 Elsevier Ireland Ltd. All rights reserved.

Background: Infertility treatment has an acknowledged psychological impact on women and their partners; however, information about the development of parental well-being after child birth is inconclusive. Preimplantation genetic screening (PGS) has been suggested to increase the efficacy of infertility treatments, but the effect it may have on parental well-being is unknown.Aim: To evaluate parental distress and anxiety at one and two years after successful infertility treatment and to explore variables that might affect parental outcome, including PGS and child behaviour.Study design: Follow-up of a randomised controlled trial (RCT) on the efficacy of PGS.Subjects: Parents (n = 101) that successfully underwent IVF/ICSI with or without PGS.Outcome measures: At one and two years, parental distress and anxiety were assessed with the General Health Questionnaire 30 and State Trait Anxiety Inventory, respectively. At two years, child development and behaviour were assessed with the Dutch Bayley Scales of Infant Development-II and the Child Behaviour Checklist 11/2-5, respectively.Results: PGS had no effect on parental distress or anxiety. Child behaviour problems were associated with parental distress and anxiety. There was a main effect of time on parental distress, with distress levels decreasing over time.Conclusions: We found no objection to PGS related to parental psychological distress and anxiety. When parental psychological problems are present after infertility treatment, the results of this study could be useful to support counselling. (c) 2012 Elsevier Ireland Ltd. All rights reserved.

BackgroundLate-onset sepsis is a relatively common complication particularly of preterm birth that affects approximately a quarter of very low birth weight infants.AimWe aimed to determine the motor, cognitive, and behavioural outcome at school age of preterm children with late-onset sepsis compared to matched controls.Study design and subjectsA prospective case–control study that included preterm infants (gestational age

article i nfo Preterm infants Prenatal tobacco exposure Cerebral oxygenation Near-infrared spectroscopy Fractional tissue oxygen extraction Aim: Our aim was to determine the influence of prenatal tobacco exposure on regional cerebral tissue oxygen saturation (rcSO2) and fractional tissue oxygen extraction (FTOE) in preterm infants. We hypothesized that as a result of vasoconstriction caused by prenatal tobacco exposure rcSO2 would be lower and FTOE would be higher during the first days after birth in infants exposed to tobacco during pregnancy. Methods: Sixty preterms were included in this prospective, observational cohort study (median gestational age 29.9 weeks, range 26.0-31.8, median birth weight 1248 g, range 615-2250). Fourteen infants had been exposed to tobacco during pregnancy. All mothers smoked more than five cigarettes a day till delivery. We measured rcSO2 and transcutaneous arterial oxygen saturation (tcSaO2) in all infants on days 1-5, 8, and 15. FTOE was calculated: FTOE=(tcSaO2 −rcSO2)/tcSaO2. Results: In preterm infants exposed to tobacco during pregnancy, rcSO2 was lower during days 1, 2, and 8 after birth, median 73% versus 81%, 73% versus 80% and 71% versus 78% respectively. FTOE was higher during days 1 and 8 after birth, median 0.24 versus 0.15 and 0.26 versus 0.19 respectively. On the second day, FTOE tended to be higher, 0.18 versus 0.14. Conclusions: During the first two days and day 8 after birth cerebral oxygen saturation is lower and oxygen extraction higher in preterm infants following prenatal tobacco exposure. Our data suggest that prenatal tobacco exposure may have an effect on cerebral oxygenation of the infant.

Background: Infants with congenital heart disease (CHD) are at risk for brain injury. An accurate tool to monitor brain function is amplitude integrated EEG (aEEG). It records both background patterns and electrographic seizure activity (EA).Aims: Our aim was to determine aEEG patterns in infants with CHD and to determine the differences between infants with a cyanotic or an acyanotic CHD.Study design and subjects: Sixty-two full term newborns had either a cyanotic CHD (transposition of the great arteries (n=24)) or an acyanotic CHD (hypoplastic left heart syndrome (n=26). critical aortic valve stenosis (n=1) or aortic coarctation (n=11)). The background patterns, sleep-wake cycling (SWC), and EA were assessed. The first 72 h after starting prostaglandin E-1-therapy were used for analysis.Results: The background patterns were mildly abnormal in 45% of the infants and severely abnormal at some point during the recording in 14% of the infants. We found no differences in background patterns between the two groups. EA was present in 12 (19%) infants. EA was more frequent in infants with acyanotic CHD (OR 9.4, 95% CI 1.1-78, p=0.039). SWC was equally frequent in infants with cyanotic and infants with acyanotic CHD. A severely abnormal aEEG and EA were associated with more profound acidosis.Conclusions: Before surgery the majority of infants with a CHD had an abnormal aEEG. aEEG helped to identify EA and it was a useful tool to evaluate brain function prior to surgery in CHD. (C) 2010 Elsevier Ireland Ltd. All rights reserved.

Background: Qualitative aspects of the motor repertoire, at 11-16 weeks post-term are predictive for minor neurological dysfunction (MND) at 7 to 11 years of age. Predictive value of quantitative aspects is unknown so far.Aim: To investigate whether quantitative aspects of the motor repertoire between 6 and 24 weeks post-term also have predictive value for neurological outcome at 7 to 11 years of age.Study design: Prospective cohort study.Subjects: Preterm infants from whom several quantitative aspects of the motor repertoire were assessed between 6 and 24 weeks post-term.Outcome measures: Neurological outcome at 7-11 years of age was assessed according to Touwens' neurological examination. Children were classified as neurologically normal, or as having complex MND or cerebral palsy (CP).Results: Eighty-two children were included. At 7 to 11 years of age 15 children (18%) had developed CP, 49 (60%) were neurologically normal, and 18 (22%) had MND. Multiple logistic regression analysis showed that, when the qualitative aspects of the motor repertoire known to predict neurological outcome were taken into account, only the asymmetric tonic neck (ATN) posture provided additional predictive value. In case of normal fidgety movements (FMs) accompanied by an abnormal concurrent motor repertoire, the presence of an obligatory ATN increased the risk for developing complex MND to 75%; absence of an obligatory ATN reduced the risk to 15% (pConclusions: Quantitative aspects of the motor repertoire at 11-16 weeks post-term, in particular the presence of an obligatory ATN posture, contribute to the prediction of neurological outcome at 7 to 11 years of age. (C) 2008 Elsevier Ireland Ltd. All rights reserved.

Background: Prechtl's method on the qualitative assessment of general. movements (GMs) is a powerful toot for early and specific prediction of cerebral palsy. However, it is uncertain whether the GM assessment can be used to predict mild neurological impairment.Aims: To determine whether the quality of general. movements (GMs) from the age of 3 to 5 months, i.e. fidgety movements, is related to the presence of complex minor neurological dysfunctions (MND) 13 to 15 years later.Study design: Prospectively collected data on the quality of GMs during infancy were retrospectively analysed on the basis of MND at puberty.Subjects: Twenty-eight participants (14 girls and 14 boys) with a median gestational age of 40 weeks (range: 35 to 42 weeks) and an appropriate birth weight (median 3390 g; range 1900 to 4200 g). Outcome measures: Touwen's neurological examination.Results and conclusions: Abnormal fidgety movements were not related to later complex MND, but to fine manipulative disabilities (p

Background: The assessment of the quality of general movements (GMs) in young infants is a reliable and valid diagnostic tool for detecting brain dysfunction early in Life. Poor repertoire GMs are the most frequently observed abnormal GMs during the preterm, term and early postterm period. However, their predictive value for the neurological outcome is low.Aim: To find out whether a detailed scoring of poor repertoire GMs might lead to a better prediction of the neurological outcome.Subjects: We studied 18 preterm infants who were repeatedly videoed from birth to 22 weeks postterm age, including several recordings assessed as poor repertoire GMs. At 8 to 10 years, six children were neurologically normal, six had mild neurological abnormalities, and the remaining six were classified as cerebral palsy.Study design: Each GM globally assessed as poor repertoire was scored in details according to several aspects of neck and trunk, arm and Leg movements applying Prechtl's optimality concept.Results: By and large, the detailed score of poor repertoire GMs was not related to the neurological outcome.Conclusion: For the clinical application of the GM assessment, it remains important to assess the fidgety movements of those infants with poor repertoire GM trajectories in order to predict their outcome. (C) 2005 Elsevier Ireland Ltd. All rights reserved.

Background: Developmental testing in children is concerned mainly with a pass or fail on tasks such as grasping, manipulating and inserting. Knowledge about the qualitative development of hand movements in young children is scarce. Aim: We studied the qualitative development of manipulative hand movements in 14-, 18- and 25-month-olds. Study design and subjects: Twenty-six children were videoed during grasping, manipulating and inserting cubes into a cup or box and pegs into a peg-board. Results: We found clear-cut, object-related results. The right hand was used mainly to grasp, manipulate and insert the pegs, while no hand preference was found for the cube. Generally, the quality of grasping and inserting did not change with age. At 18 months, the performance was more optimal if the children used pegs rather than cubes. The adjustment of hand opening became more adapted with increasing age when grasping the cubes; this was not observed for the pegs. Associated movements occurred less during pegging than while playing with the cubes. A variety of patterns were used for pegging. Besides a difference in band preference between girls and boys, some patterns became more prominent with increasing age. The success rate increased with age but was independent of the pattern used. Conclusion: This study stresses the need of a clear understanding of the entire spectrum of normal motor development. This knowledge forms the basis on which abnormalities, even of such common movement patterns as grasping, manipulating and inserting, can be reliably diagnosed in neurologically impaired infants and children. (C) 2003 Elsevier Ireland Ltd. All rights reserved.

Background: Infants with normal fidgety movements at 3 to 5 months after term are very likely to show neurologically normal development, while the absence of fidgety movements is an early marker for an adverse neurological outcome, mainly cerebral palsy (CP). The clinical significance of so-called sporadic fidgety movements (i.e., fidgety movements occur isolated in a few body parts and are of 1- to 3-second-duration) is not yet known.Aims: Our objective was to determine whether infants who had developed CP and had sporadic fidgety movements have a better outcome than infants who did not have fidgety movements.Study design: Longitudinal study. Retrospective analysis of prospectively collected data.Subjects: 61 infants who developed CP (46 male, 15 female; 29 infants born preterm; videoed for the assessment of movements and postures at 9 to 16 weeks post-term age).Outcome measures: The Gross Motor Function Classification System (GMFCS) was applied at 3 to 5 years of age.Results: There was no difference between children diagnosed with CP who had sporadic fidgety movements at 9 to 16 weeks post-term age (n = 9) and those who never developed fidgety movements (n = 50) with regard to their functional mobility and activity limitation at 3 to 5 years of age. One infant had normal FMs and developed unilateral CP, GMFCS Level I; the remaining infant had abnormal FMs and developed bilateral CP, GMFCS Level II. Conclusions: There is no evidence that the occurrence of occasional isolated fidgety bursts indicates a milder type of CP. (C) 2015 Elsevier Ireland Ltd. All rights reserved.

To investigate the psychometric properties of the Dutch version of the 48 months Ages and Stages Questionnaire (D_ASQ_48).Prospective cohort study of a community-based sample of children born in 2002 and 2003 whose parents filled out the D_ASQ_48 and a questionnaire on school status at 60 months. The ASQ was translated into Dutch and back-translated into English by three independent translators.Well Child Centers covering 25% of the Netherlands.Parents of 1510 preterm and 562 term children born in 2002-2003 attending routine Well Child visits at age 45-50 months.Reliability, validity and mean population scores for D_ASQ_48 compared to other countries.Mean population scores for the D_ASQ_48 were mostly similar to those in the USA, Norway and Korea. Exceptions (effect sizes of difference0.5) were problem solving (USA) and fine motor (Korea). Reliability was good for the total score (Cronbach alpha 0.79) and acceptable for all domains (0.61-0.74). As expected, infants born at gestational age32 weeks, children from low income families, of low educated mothers, and boys were more likely to fail on several domains (odds ratios, OR ranging from 1.5 to 4.9). The only unexpected association concerned children from one-parent families. Sensitivity to predict special education at five years of age was 89% and specificity 80%.The good psychometric properties of the Dutch ASQ_48 and the small differences when compared to other countries support its usefulness in the early detection of developmental problems amongst children worldwide.

We describe the state of the art of Prechtl's method for the qualitative assessment of general movements as a diagnostic tool for early detection of brain dysfunction, After discussing the optimal technique for video recording general movements in preterm, term and young infants, attention is focused on the proper analysis of this spontaneous motor pattern. Recently, a group of active researchers in the field reached consensus on the various qualities of normal and abnormal general movements. These definitions are reported here in full. Since it is a newly introduced method careful investigation into its reliability is required. Various groups of investigators have obtained data which demonstrate the robust character of the method (interscorer agreement: 78-98%). Finally, we discuss the validity of this early assessment method on the basis of the reports published so far. While the method's sensitivity is similar in all age groups studied (preterm, term, first month, second month, and third month age epochs), and averages 94.5%, the specificity of the method is age-dependent. It is low during the early ages, increases gradually and reaches 82 to 100% at 3 months post-term. This phenomenon is explained by spontaneous recovery of early dysfunction. In contrast, consistent abnormalities of general movements are Linked to neurological deficits found at the 2 year follow-up. (C) 1997 Elsevier Science Ireland Ltd.

The developmental course of the quantitative aspects of early spontaneous motility was studied longitudinally in fourteen intrauterine growth-retarded infants, with a birth weight below the 5th percentile, in relation to perinatal variables, brain ultrasound findings and neurological outcome. Quantitative motility was studied during the preterm period until term age, from 1 h videotape recordings, using Prechtl's classification of different spontaneous movement patterns. Comparison to a low-risk reference group, consisting of preterm, appropriate-for-gestational age infants, showed that significant differences were inconsistent and obviously by chance, with the possible exception of a decreased rate of startles from the 2nd to the 6th postnatal weeks. A trend of increasing duration of GMs was present with increasing postnatal age. There were hardly any correlations between perinatal variables and quantitative motility, and if present the correlations were weak. Such correlations were found between the reduction of heart-rate variability on cardiotocography and the rate of startles and twitches during the first week and furthermore between the neonatal blood glucose level and the rate of isolated arm movements and total motility during the first week. This study demonstrates that intrauterine growth retardation has little or no influence on the quantitative aspects of spontaneous motility postnatally during the preterm period.