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Head circumference in ELBW babies is associated with learning difficulties and cognition but not ADHD in the
S L Stathis1, M O'Callaghan, J Harvey
1Developmental Pediatrics, Mater Children's Hospital, South Brisbane, Australia.
Insights
Small head circumference and slow head growth in infants predict later learning difficulties. These early indicators are linked to academic challenges but not attention-deficit-hyperactivity disorder (ADHD).
Area of Science:
- Pediatrics
- Developmental Neuroscience
- Educational Psychology
Background:
- Extremely-low-birthweight (ELBW) infants face risks for developmental challenges.
- Early identification of potential learning difficulties is crucial for timely intervention.
Purpose of the Study:
- To investigate if small head circumference (HC) and low head-circumference growth velocity (HGV) in the first year predict school-age learning, cognitive, and concentration outcomes.
- To assess the association between early head growth parameters and academic performance, intellectual ability, and attention-deficit-hyperactivity disorder (ADHD).
Main Methods:
- Longitudinal study of 124 ELBW infants followed from birth to 6 years.
- Head circumference (HC) and head-circumference growth velocity (HGV) z-scores calculated using British growth data.
- School-age assessments included teacher questionnaires for academic performance, Du Paul Rating Scale for ADHD, and McCarthy Scale for intellectual ability.
Main Results:
- Small HC (< 3% or 3-10%) at 8 months strongly predicted learning problems (P=0.004) with moderate sensitivity and specificity.
- Low HGV (<= 10%) from birth to 4 months showed high specificity (98%) and PPV (88%) for learning problems, despite lower sensitivity (20%).
- Early HC and HGV were significantly associated with lower cognitive ability at 6 years, but not with ADHD.
Conclusions:
- Early markers of small head size and slowed head growth in ELBW infants are significant predictors of later learning difficulties and cognitive deficits.
- These findings highlight the potential for early screening using head growth parameters to identify at-risk children.
- Further research may explore interventions to mitigate these developmental risks in ELBW populations.
Abstract:
This study examines whether a small head circumference (HC) and low head-circumference growth velocity (HGV) during the first year of life predict consequences at school age in learning, cognition, and concentration. A total of 124 extremely-low-birthweight (ELBW) infants (birthweight 500 to 999 g) born between 1977 and 1986 were eligible for follow-up at the corrected ages of 4, 8, and 12 months and 2, 4, and 6 years. Infants were categorized as having a small HC (< 3% or 3 to 10%) on the basis of the 1990 British growth data which allowed standardized z-scores to be calculated for HC, independent of gestation and corrected age. HGV measurements were calculated using differences in the HC z-scores. In 1995, parents of 87 children agreed to participate in a study of learning and attention at school age. Attention-deficit-hyperactivity disorder (ADHD) was assessed using the Du Paul Rating Scale. Academic performances were based on a teacher questionnaire dealing with aspects of reading, writing, mathematics, and spelling. A child was considered to have a learning difficulty if academic problems were present in at least one of these four areas. Intellectual ability was assessed using the McCarthy Scale at 6 years. HC < 3% and 3 to 10% at 8 months' corrected age was strongly associated with school-aged learning problems (P=0.004), with a moderate specificity (70%), positive predictive value (PPV) (67%), and sensitivity (67%). HGV < or = 10% from birth to 4 months was also associated with learning problems at school age (P=0.01) with a higher specificity (98%) and PPV (88%) but lower sensitivity (20%). A logistic regression analysis was performed with the risk for learning difficulties at 8 months as the dependent variable. Sex, gestation, birthweight, multiple births, and a history of intraventricular hemorrhage did not substantially alter the unadjusted odds ratio (4.7; 95% CI 1.9 to 13.6). Maternal age and education did not confound the relation. No association was found between HC or HGV and ADHD. HC < 3% at 4 months (P<0.02), 8 months (P=0.02), and 12 months (P=0.04), and HGV between birth and 4 months (P<0.01) were significantly associated with low cognitive ability at 6 years.