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Neonatal and neurodevelopmental significance of behaviour in very low birthweight children
Insights
Attention Deficit Disorder (ADD) affects 34% of very low birthweight survivors. Neonatal complications and developmental assessments at two years predict ADD in these vulnerable infants.
Area of Science:
- Neonatalogy
- Developmental Pediatrics
- Neurodevelopmental Disorders
Background:
- Very low birthweight infants face significant neurodevelopmental risks.
- Attention Deficit Disorder (ADD) is a common concern in this population.
- Early identification and understanding of risk factors are crucial for intervention.
Purpose of the Study:
- To determine the prevalence of Attention Deficit Disorder (ADD) characteristics in very low birthweight survivors at two years corrected age.
- To identify neonatal variables associated with ADD in this cohort.
- To explore the relationship between neonatal factors, developmental status, and ADD.
Main Methods:
- Longitudinal study of 213 inborn infants with birthweight < 1500g.
- Psychological testing at 2 years corrected age using Bayley Scales of Infant Development.
- Paediatric and neurological examinations at 2 years.
- Stepwise discriminant function analysis to identify predictive neonatal variables.
Main Results:
- 34% of survivors exhibited ADD characteristics at two years.
- Significant agreement between paediatrician and psychologist diagnoses of ADD.
- Five key neonatal variables (necrotizing enterocolitis, bronchopulmonary dysplasia, major apnoeas, IV fat duration, discharge weight percentile) predicted ADD with 69% accuracy.
- Children with ADD showed lower mental scores, smaller head circumference, increased tone disorders, poorer coordination, and more disabilities.
Conclusions:
- Behavioral outcomes at two years in very low birthweight infants reflect neonatal experiences.
- Neonatal complications are significant predictors of later Attention Deficit Disorder (ADD).
- Early neurodevelopmental status and physical findings at two years correlate with ADD and past neonatal challenges.
Abstract:
73 (34%) of 213 inborn, long term survivors with a birthweight less than 1500 g showed characteristics of Attention Deficit Disorder (ADD) during psychological testing at 2 years of age corrected for prematurity. Agreement on the diagnosis of ADD made by the paediatrician and psychologist in separate examinations was statistically significant. Children with ADD differed from those with normal behaviour on a large number of neonatal variables which were reduced to the following five on stepwise discriminant function analysis: necrotizing enterocolitis, bronchopulmonary dysplasia, major apnoeas requiring bag and mask resuscitation, duration of feeding on intravenous fat and weight percentile at discharge. These neonatal variables correctly classified 69% of children into their actual behaviour group at 2 years. On psychological testing, children with ADD had a significantly lower mental score on the Bayley Scales of Infant Development and were found on their paediatric/neurological examination at 2 years to have a significantly smaller head circumference, more tone disorders, poorer visual tracking and visual motor co-ordination, poorer gross and fine motor co-ordination and significantly more minor physical and neurological disabilities than normally behaved children. The behaviour of very low birthweight infants during formal psychological testing at 2 years is a potent indicator of past neonatal experience and current neurodevelopmental status.