Poster workshop
Chairs: Magda Kalm‡r and Judith M. Gardner
Discussant: Bernard Z. Karmel
Changing cohorts and advances in medical practices make the evaluation andfollow-up of high-risk infants a continuing research and clinical challenge.Although adverse effects of severe brain insult have been well documented,less is known about more subtle degrees of CNS involvement found inhigh-risk infants. Moreover, the specific neonatal problems that arepredictive of poor outcome in selected areas of later functioning are notwell understood, especially those responsible for subtle deficits inspecific areas such as fine motor skills, language processing, socialinteractions, attention, hyperactivity, and other contributors to cognitivedevelopment.. This becomes increasingly important as the incidence of majordisabilities decreases and the incidence of these more specific deficitsincreases. This poster workshop presents a series of studies thatinvestigate new research practices and refinement of existing measures tostudy different aspects of neonatal evaluations and longitudinal follow-upof infants at risk for poor developmental outcome due to a number of factorsincluding prematurity and birth asphyxia. These studies investigate a widespectrum of neonatal risk factors and neurobehavior including both clinicaland research procedures that measure sensory function as well as spontaneousand elicited motor function. Different studies address the issues oflongitudinal sequelae in the areas of language, mother-infant interactions,motor systems, and cognitive development during infancy and through theearly preschool years. The integration of these studies provides an overviewof recent work in this ever important and constantly evolving area ofresearch.
Details of individual items:
poster
In the evaluation of high-risk newborns, one important but difficult toachieve goal is the early prediction of long-term outcome. The use ofconverging operations in the neonatal period may provide a more accuratebasis for this prediction. We report here on the preliminary results of therelation between 2 procedures, one measuring spontaneous and the othermeasuring elicited motor behavior, to each other and to Bayley Scales ofInfant Development (BSID I & II) at 4 months. Spontaneous motor behavior wasjudged globally as normal or abnormal using the qualitative assessment ofvideotaped recordings of general movements (GMs) developed by Prechtl.Videotapes of GMs were made prior to hospital discharge and at 1, 3, and 4months postterm age. Elicited motor behavior was judged as normal orabnormal using our neonatal neurobehavioral (NB) assessment procedure, whichis a categorical clinical evaluation of elicited sensory and motor systems,emphasizing active motor patterns developed by Katona. It is administeredprior to hospital discharge, and at 1 month postterm age. Previous researchhas shown that the NB has concurrent validity to CNS structural andfunctional pathology as documented by neonatal cranial ultrasonography (US)and brainstem auditory evoked response (ABR) tests. Infants with differenttypes and degrees of CNS pathology have different patterns of NBabnormalities, as well as lower BSID scores at later ages, providingevidence for the predictive validity of the NB procedure in a high-riskpopulation.Infants were participants in our ongoing longitudinal follow-up program forhigh-risk infants in which the protocol includes US and ABRs during the NICUstay, NB evaluation prior to hospital discharge, and follow-up behavioraltesting every 3 months starting at 1 month postterm age. Results are basedon the first 20 NICU infants with GM data complete through 4 months. Infantshad a mean gestational age of 29.2 weeks (+/- 4 weeks; range24-38), a meanbirthweight of 1289 g (+/- 714 g; range624-2948) and varying types anddegrees of CNS injury. We found evidence for concurrent validity between theNB and GM measures at some but not all ages. The NB and GM were correlatedprior to hospital discharge, but not at 1 month, most likely reflectingdifferent patterns of recovery at this transitional age. In addition, GMs at4 months tended to be correlated to BSID scores at 4 months. There also wasevidence for predictive validity, mainly with respect to NBs, with thenewborn NB predicting GMs at 1 month, the newborn and 1 month NB tending topredict BSID scores at 4 months, and the 3 month GM predicting GMs at 4months. Continued follow-up is necessary in order to determine the relationof these early measures to long-term outcome, but these results suggest thatearly patterns of performance on converging measures of spontaneous andelicited movements may provide a promising approach to the prediction oflater function.
poster
Although standard practices suggest that differentiation of developmentaldefect from delay is not likely prior to 6 months of age, our evaluations ofelementary motor function (e.g., unsupported sitting in space, crawling upand down a slide, activated rotation, pulling to sit) indicate we are ableto make this differentiation by 2-3 months. This methodology was tested byearly investigation and clinical follow up of more than 3000 infants (1-24months) who included both normal and brain-injured (asphyxiated as well asmalformations) term and preterm infants. Brain imaging, EEG, evokedpotentials, polygraphy and the investigation of precognitive functions wereperformed in all cases. We found that the coincidence of delay, rather thanabnormal, sensorimotor development together with defects in attention,working memory, environmental contact, and activity was a reliable sign oflater mental disability, while abnormal sensorimotor development was morepredictive of cerebral palsy. We propose that early symptoms of defectivemental development may be detected by using the combination of elementarysensorimotor patterns and tests of precognitive functions.
poster
The role of perinatal risks in the continuity or discontinuity of development is ambiguous. Within a population consisting of both risk and non-risk infants those affected by biological hazards are likely to constitute, at least in the early period, a distinct, somewhat handicapped subgroup. Within the risk samples, however, the effects of perinatal insults are usually related to a host of unknown factors which make the outcome hard to predict. Our ongoing follow-up study is concerned with the developmental patterns in infants born prematurely. In this presentation findings of the first data collection points will be reported. Thirty-five preterm infants who were born at gestational ages of 29-32 weeks, with birth weights less than 2000 grams, and had no severe perinatal complications participated in the study. The Brazelton Neonatal Assessment Scale (BNBAS) was administered to the babies at two weeks post-term. At 6-8 months corrected age the infants were tested using the Bayley Scales of Infant Development (BSID-II) and were observed in interacting with their mothers in feeding and free play situation. The measured variables of perinatal status had some albeit limited effects on the neonatal behavioural organisation. The restricted heterogeneity of the sample was likely to attenuate the correlations. BNBAS items related to the newborn organismAEs energy reserves and reactivity predicted both the MDI and PDI. A few correlations suggested some continuity in behavioural characteristics but the perinatal risk seemed to confound the patterns. Links between neonatal baby variables and later maternal behaviour are interpreted as indicators of a transactional mechanism.
poster
In addition to the biological hazards of the untimely requirement ofadaptation to the extra-uterine life the interaction of unprepared andstressed mothers with their immature babies may involve further risks. Thepresent study aims to contribute data to our understanding of the beginningsof mother - infant relationship by comparing preterm and full-term newbornbabies' and mothers' behaviours in dyadic situation. Thirty-five preterm andforty full-term babies and their mothers participated in the study. Thepreterm infants were born at 29-32 weeks of gestation, weighing less than2000 grams, and had no severe perinatal complications. The comparison groupconsisted of healthy full-term neonates. The dyads were observed forapproximately 10 minutes in a situation with no caregiving tasks. Themothers were not given any specific instruction. The interactionalsituations were videotaped. Events were coded using rating scales ofmaternal and infant behaviours and measures of synchrony. Factor analyses ofthe single item scores yielded 5 maternal and 3 baby factors. Mothers offull-term infants were verbally more active and made more efforts tomaintain eye contact. Full-term babies were somewhat more alert andresponsive, while the preterms displayed less discomfort. Distinct patternsof correlations between maternal and infant measures emerged in function ofthe babies' birth status.
poster
Several studies have shown that early preterm birth can affect generalcognitive and linguistic development until school age (Barsky and Siegel,1992). However, only a few studies have investigated the influence of earlypreterm birth on specific linguistic competencies. A recent study showedthat some <33-weeks-GA preterms at 3-4 years have difficulties in languagecomprehension, production and repetition of non words (Gathercole et al.,1998).The aim of this study was to investigate morphosyntactic competencies at 2 ½and 3 ½ years in Italian very-early preterms taking into account an index ofbiological risk given by the amount of neonatal sufferance and the level ofmother's and father's education. It was also aimed to see whethermorphosyntactic competencies were related with cognitive and phonologicalcompetencies and whether 2 ½ years' performances predicted 3 ½ years' ones.A preterm group of 40 subjects (mean GA 30 weeks), without neurological norsensorial or motor deficits, and an at term group of 20 healthy subjects(mean GA. 39,5 weeks) took part in the study. Level of mothers' and fathers'education and type of occupation was comparable in the two groups. Subjectswere videorecorded while examined at 2 ½ and 3 ½ years, corrected age forpreterms, with two tests: the Stanford-Binet (L-M) test; an Italianmorphosyntatic test of repetition of sentences of different complexity andlength accompanied with pictures (Devescovi et al., 1992).The significant results are the following:- Preterms have a mean IQ lower than at terms' IQ, even if all pretermsexcept a few, have a IQ >85. <31-weeks-GA. preterms have lower IQs thanpreterms with longer GA.- Preterms at both 2 ½ and 3 ½ years make more morphological mistakes, i. e.omissions and errors of articles, verbs, nouns and prepositions, than atterms.- In preterms, IQ and morphological mistakes are positively correlated withthe biological risk index, i.e. more the neonatal sufferance, higher therisk of cognitive and linguistic difficulties.- In both preterms and at terms, morphological mistakes are negativelycorrelated with IQ.- In preterms, but not in at terms, morphological mistakes are negativelycorrelated with years of maternal education.- In preterms, but not in at terms, phonological mistakes are negativelycorrelated with IQ and positively correlated with morphological mistakes.- In preterms, 2 ½ years' IQ and morphological mistakes are correlated with3 ½ years' ones.In conclusion, preterms at 2 ½ and 3 ½ years show mild difficulties incognitive and morphological domains especially in case of high biologicalrisk and low maternal education. Morphological mistakes are correlated withIQ both in preterms and at terms, probably because those competencies dependon a general working memory process. Instead, phonological mistakes arecorrelated with morphological ones in preterms but not in at terms. Whetherlinguistic development in preterms is only delayed or also different in someprocesses from that of at terms remains to be investigated.
poster
A growing bulk of evidence suggests that although the majority of lowbirthweight infants attain normal intelligence they are at increased riskfor various developmental disorders. Results concerning the prediction ofoutcome are inconclusive.In this presentation follow-up data of 164 low-birthweight (< 2500 grams)children will be reported. Two third of the sample were born preterm andone third were full-term SGA infants. Developmental outcome was assessedusing the Brunet-Lezine Developmental Scale at ages 1 and 2 years and theWPPSI and further motor, visual-motor, and attention scales at age 5 years.The overall outcome for the LBW children in terms of the mean IQ wasreassuring. However, the variance of IQ was huge, ranging from severeretardation to outstanding performances. As far as the mean scores areconcerned the motor and visual-motor scales appeared to be more sensitive tothe group-level perinatal disadvantage. Both the degree of maturity andperinatal illness contributed to the outcome. Gestational Age had acontroversial impact in that it correlated positively with some outcomemeasures and negatively with others. The predictability of the 5-yearoutcome was tested by various regression models. Combinations of perinatalstatus variables, infant development measures, and SES explained 43-53 % ofthe variance of outcome. One- and two-year Brunet-Lezine scoressignificantly correlated with the 5-year outcome. The 2-year DevelopmentalQuotient was entered first in each stepwise multiple regression equation.The preterm and the full-term SGA subgroups displayed differentiallongitudinal patterns.
poster
no abstract