Neurodevelopment Follow up of Premature and Low Birth Weight
Infant who are born born preterm are at increased risk for medical and developmental morbidity. Several decades of research have clearly identified premature infants, particularly those with low birth weight, as a group at risk for later cognitive and motor deficits. Developmental outcomes, however, have been variable in samples of these infants. Some premature infants develop normally from the first months; others whose initial development is delayed catch up; and still others continue to exhibit learning and behavioral difficulties throughout the school years. Over 60 years of research have not produced clear-cut conclusions about which of these infants are most likely to experience long-term problems. Advances in prenatal and neonatal care during the last few decades have made it possible for infants born extremely prematurely to survive. Concerns have been expressed about the long term outcome of these infants. In recent follow up surveys, the neurodevelopmental impairment rate of low birthweight infants has not changed significantly, and the disability rate of the most immature infants has remained considerable. Kitchen et al31 suggested that neurological findings at 2 years of age are too pessimistic, and that 33% of children had a poorer diagnosis at that age than at 5, and in only 4% was the outcome at 2 years of age better than at 5. However, in comparison with normal weight children, Halsey et al32 has shown that ELBW children classified as non-disabled at an early age show a significantly poorer performance on cognitive, verbal, perceptual, motor, and visual-motor measures at preschool age,
Interviews with parents of preterm and full-term NIC 6.5 year old children indicated that NIC children were were older than control children when they reached certain stages in language development (short sentences, intelligible speech). Absence of babbling was more common in NIC children born at 23-27 wk and occurrence of stuttering was more commonly noticed in preterm NIC children born at 23-27 wk.
Preterm birth and associated hazards may constitute a significant risk factor for specific language impairment in a sizable minority of children.” Preterm children had lower scores for vocabulary, expressive language, phonological short-term memory, and general nonverbal ability. These lower scores were primarily based on results from 1/3 of the 26 preterm children who were identified as being “at risk” for persisting language difficulties.
Speech and language comprehension and production of 55 preterm children, 5 years old, were compared to children born full term of the same age. Mean performance for preterm children was significantly lower on most of the measures including the composite IQ scores. However, when nine children with major neurological disabilities were excluded statistically significant differences were found on only 4out of 12 of the speech and language measures. Preterm children were slower on rapid word retrieval and also had difficulties in comprehending relative concepts. This was believed to suggest ‘subtle dysnomia’ indicative of later reading problems.
Preterm children did not exhibit problems with global verbal measures or basic speech and language aspects. In fact, specific language impairment (defined as a discrepancy of > 1SD between Performance IQ and Verbal IQ scores) was more common in the control group. Boys were found to have a greater discrepancy between their Performance and Verbal IQ scores.
Children who had been in the NICU with respiratory disorders as newborns, either pre-term and or full-term newborns with asphyxia, were studied at preschool age. Newborns with hearing loss and mental retardation were excluded from this study. Complications of delivery, birthweight, hypoxia, persistent ductus arteriosus, duration of ventilation and complications of respiratory treatment were correlated with perception and comprehension issues. The intelligence level of pre-school children is found to be closely correlated to speech perception and comprehension
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