Survival and major neurodevelopmental impairment in extremely low gestational age newborns born 1990–2000: a retrospective cohort study

<p>Abstract</p> <p>Background</p> <p>It is important to determine if rates of survival and major neurodevelopmental impairment in extremely low gestational age newborns (ELGANs; infants born at 23–27 weeks gestation) are changing over time.</p> <p>Methods</p> <p>Study infants were born at 23 to 27 weeks of gestation without congenital anomalies at a tertiary medical center between July 1, 1990 and June 30, 2000, to mothers residing in a thirteen-county region in North Carolina. Outcomes at one year adjusted age were compared for two epochs of birth: epoch 1, July 1, 1990 to June 30, 1995; epoch 2, July 1, 1995 to June 30, 2000. Major neurodevelopmental impairment was defined as cerebral palsy, Bayley Scales of Infant Development Mental Developmental Index more than two standard deviations below the mean, or blindness.</p> <p>Results</p> <p>Survival of ELGANs, as a percentage of live births, was 67% [95% confidence interval: (61, 72)] in epoch 1 and 71% (65, 75) in epoch 2. Major neurodevelopmental impairment was present in 20% (15, 27) of survivors in epoch 1 and 14% (10, 20) in epoch 2. When adjusted for gestational age, survival increased [odds ratio 1.5 (1.0, 2.2), p = .03] and major neurodevelopmental impairment decreased [odds ratio 0.54 (0.31, 0.93), p = .02] from epoch 1 to epoch 2.</p> <p>Conclusion</p> <p>The probability of survival increased while that of major neurodevelopmental impairment decreased during the 1990's in this regionally based sample of ELGANs.</p

Cerebral Palsy:Early Markers of Clinical Phenotype and Functional Outcome

The Prechtl General Movement Assessment (GMA) has become a cornerstone assessment in early identification of cerebral palsy (CP), particularly during the fidgety movement period at 3-5 months of age. Additionally, assessment of motor repertoire, such as antigravity movements and postural patterns, which form the Motor Optimality Score (MOS), may provide insight into an infant's later motor function. This study aimed to identify early specific markers for ambulation, gross motor function (using the Gross Motor Function Classification System, GMFCS), topography (unilateral, bilateral), and type (spastic, dyskinetic, ataxic, and hypotonic) of CP in a large worldwide cohort of 468 infants. We found that 95% of children with CP did not have fidgety movements, with 100% having non-optimal MOS. GMFCS level was strongly correlated to MOS. An MOS > 14 was most likely associated with GMFCS outcomes I or II, whereas GMFCS outcomes IV or V were hardly ever associated with an MOS > 8. A number of different movement patterns were associated with more severe functional impairment (GMFCS III-V), including atypical arching and persistent cramped-synchronized movements. Asymmetrical segmental movements were strongly associated with unilateral CP. Circular arm movements were associated with dyskinetic CP. This study demonstrated that use of the MOS contributes to understanding later CP prognosis, including early markers for type and severity

Neural correlates of attention and memory in the first year of life

Our understanding of the neural correlates involved in the development of attention and memory has lagged behind our knowledge of the behavioral manifestation of these abilities. This is unfortunate, as a more complete account of the brain bases for these aspects of development would likely contribute to a more thorough understanding of cognitive development in general. In this article we review previous studies from our laboratory examining recognition memory in 4‐, 6‐, and 8‐month‐old infants, and then describe more recent work with 12‐month‐old infants. From these data we conclude that the development of recognition memory lags behind that of attention. Specifically, by 4 months infants show event‐related potential (ERP) evidence of selectively attending to stimuli presented as briefly as 100 msec. Infants this same age are also able to distinguish a single novel stimulus from a single familiar stimulus. By 6 months, infants begin to distinguish between frequently and infrequently presented events, and between familiar and novel events presented infrequently. At 8 months, infants appear able to ignore how often events have been seen and attend instead to whether these events have been seen. Finally, 12‐month‐old infants once again appear to be drawn to event frequency, suggesting a shift in how attention and memory resources are allocated from 6 to 12 months. From these findings, we conclude that recognition memory is comprised of several subcomponents that are still not completely assembled by the end of the first year of life

Visual Event-Related Brain Potentials in 4-Month-Old Infants at Risk for Neurodevelopmental Impairments

The recording of event-related potentials (ERPs) is an electrophysiologic technique that has been used to evaluate the functional maturation of neural pathways responsible for recognition memory systems in infants and children. The purpose of this study was to evaluate ERP correlates of visual recognition memory in 4-month-old infants at risk for later cognitive impairments. We compared ERPs using a test of shape recognition at 4 months of age (adjusted for prematurity) in 16 high-risk, neonatal intensive care unit (NICU) survivors and 16 healthy full-term infants. ERPs were recorded while infants were familiarized with one stimulus (a red cross, 15 trials), then tested with 60 trials of this familiar stimulus and a novel stimulus (a red corkscrew). Both the NICU and control groups' ERPs demonstrated evidence of differential processing of the two stimuli, but the NICU groups' ERP patterns were distinctly different from those of the control group. In the NICU group, the novel stimulus elicited parietal positivity at 1000-1700 ms poststimulus, whereas in the control group the novel stimulus elicited occipital and frontal negativity at 500-1700 ms poststimulus. The ERP pattern demonstrated by the NICU group was atypical as it has not been previously described in healthy infants. The results of the study indicate that the ERP technique can be used to demonstrate altered patterns of neural activity during tasks of visual recognition memory in high-risk infants. We speculate that the atypical ERP patterns described in this study may indicate that patterns of synaptic organization were altered by neonatal eventsPsycholog

Electrophysiological brain responses of six-month-old low risk premature infants

This study sought to examine the electrophysiological correlates of visual perceptual priming in a sample of low risk preterm infants. We compared the ERP data of 20 healthy preterm infants at the age of 6 months (corrected age: 4 months) to those of 20 six-month-old and 20 four-month-old full term infants. The comparison groups represented the preterm infants' chronological and corrected ages respectively. The results showed that the brain responses of the preterm infants at the age of 6 months, specifically the topography and the latency of the Nc component, are more similar to those of their corrected age peers than to those of the chronological age controls