Background: Subnormal head circumference (HC) has been associated with poor neurologic and developmental outcomes. Aim: To examine the correlates and consequences of subnormal HC in a cohort of school age, very low bi...Background: Subnormal head circumference (HC) has been associated with poor neurologic and developmental outcomes. Aim: To examine the correlates and consequences of subnormal HC in a cohort of school age, very low birth weight (VLBW, < 1500 g) children. Study design and outcome measures: We examined developmental outcomes at a mean age of 6.8 years in a cohort of 128 VLBW children born from 1982- 1986 and 58 normal birth weight controls. The VLBW cohort included a regional sample of < 750 g birth weight children and matched children with 750- 1499 g birth weight. Outcomes included an IQ equivalent, neuropsychological skills, academic achievement, adaptive behavior, and attention problems. HC was defined along a continuum and as subnormal vs. normal. Linear and logistic regressions were employed to determine the effects of HC on the outcomes after controlling for confounding variables. Results: Thirty one VLBW children (24% ) had subnormal HC vs. none of the controls. The VLBW children with subnormal HC differed significantly from the normal HC group in birth weight (748 g vs. 977 g, p < 0.001), SGA status (52% vs. 27% , p < 0.05), high neonatal risk (57% vs 29% , P < 0.05), and neurosensory impairment (23% vs 8% , P < 0.05). Even after taking these risk factors into account, subnormal HC was associated with poorer IQ equivalent, perceptual motor skills, academic achievement, and adaptive behavior. Results were similar after excluding the children with neurosensory impairment. Conclusions: Subnormal HC is associated with adverse developmental outcomes in VLBW children, independent of other risk factors. Interventions to improve antenatal and postnatal growth may contribute to better school- age outcomes.展开更多
Objective:Pediatric sleep-disordered breathing(SDB)has a disproportionatel y high prevalence in children who were preterm infants(preterm children)and is associated with behavioral comorbidity.Exposure to intermittent...Objective:Pediatric sleep-disordered breathing(SDB)has a disproportionatel y high prevalence in children who were preterm infants(preterm children)and is associated with behavioral comorbidity.Exposure to intermittent hypoxemia and sleep disruption may contribute to cognitive impairment.We quantified the assoc iation of SDB with cognition and achievement and determined whether preterm chil dren are at a differentially increased risk for SDB-related impairments.Design :Cross-sectional analyses.Setting:Urban community.Participants:Eight hundr ed thirty-five children,aged 8 to 11 years.Intervention(s):None.Main Outcom e Measures:Scores on the Peabody Picture Vocabulary Test-Revised,Kaufman Asse ssment Battery for Children,and Continuous Performance Test.Results:One hundr ed sixty-four children had SDB.In unadjusted analyses,children with SDB had p oorer scores on almost all tests of cognition and achievement.Group differences were attenuated after adjusting for socioeconomic status;in these analyses,ch ildren with SDB scored lower on the Peabody Picture Vocabulary Test-Revised(me an±SE score,100.5±1.4 vs 103.6±0.7;P=.04),and the Kaufman Assessment Batte ry for Children riddles and triangles subscales.Associations were stronger in p reterm than in full-term children.Of the sleep measures,snoring history was m ost strongly correlated with indices of cognition and achievement.Conclusions:Although moderate group differences were observed for almost all cognitive measu res,an attenuation of effects was observed once socioeconomic status was consid ered.The deficits in selective measures of academic abilities,language compreh ension,and planning and organizational skills suggest a negative impact of SDB on achievement and cognition.Stronger associations in preterm children suggest the importance of screening for snoring,a good predictor of cognitive function in this population.展开更多
文摘Background: Subnormal head circumference (HC) has been associated with poor neurologic and developmental outcomes. Aim: To examine the correlates and consequences of subnormal HC in a cohort of school age, very low birth weight (VLBW, < 1500 g) children. Study design and outcome measures: We examined developmental outcomes at a mean age of 6.8 years in a cohort of 128 VLBW children born from 1982- 1986 and 58 normal birth weight controls. The VLBW cohort included a regional sample of < 750 g birth weight children and matched children with 750- 1499 g birth weight. Outcomes included an IQ equivalent, neuropsychological skills, academic achievement, adaptive behavior, and attention problems. HC was defined along a continuum and as subnormal vs. normal. Linear and logistic regressions were employed to determine the effects of HC on the outcomes after controlling for confounding variables. Results: Thirty one VLBW children (24% ) had subnormal HC vs. none of the controls. The VLBW children with subnormal HC differed significantly from the normal HC group in birth weight (748 g vs. 977 g, p < 0.001), SGA status (52% vs. 27% , p < 0.05), high neonatal risk (57% vs 29% , P < 0.05), and neurosensory impairment (23% vs 8% , P < 0.05). Even after taking these risk factors into account, subnormal HC was associated with poorer IQ equivalent, perceptual motor skills, academic achievement, and adaptive behavior. Results were similar after excluding the children with neurosensory impairment. Conclusions: Subnormal HC is associated with adverse developmental outcomes in VLBW children, independent of other risk factors. Interventions to improve antenatal and postnatal growth may contribute to better school- age outcomes.
文摘Objective:Pediatric sleep-disordered breathing(SDB)has a disproportionatel y high prevalence in children who were preterm infants(preterm children)and is associated with behavioral comorbidity.Exposure to intermittent hypoxemia and sleep disruption may contribute to cognitive impairment.We quantified the assoc iation of SDB with cognition and achievement and determined whether preterm chil dren are at a differentially increased risk for SDB-related impairments.Design :Cross-sectional analyses.Setting:Urban community.Participants:Eight hundr ed thirty-five children,aged 8 to 11 years.Intervention(s):None.Main Outcom e Measures:Scores on the Peabody Picture Vocabulary Test-Revised,Kaufman Asse ssment Battery for Children,and Continuous Performance Test.Results:One hundr ed sixty-four children had SDB.In unadjusted analyses,children with SDB had p oorer scores on almost all tests of cognition and achievement.Group differences were attenuated after adjusting for socioeconomic status;in these analyses,ch ildren with SDB scored lower on the Peabody Picture Vocabulary Test-Revised(me an±SE score,100.5±1.4 vs 103.6±0.7;P=.04),and the Kaufman Assessment Batte ry for Children riddles and triangles subscales.Associations were stronger in p reterm than in full-term children.Of the sleep measures,snoring history was m ost strongly correlated with indices of cognition and achievement.Conclusions:Although moderate group differences were observed for almost all cognitive measu res,an attenuation of effects was observed once socioeconomic status was consid ered.The deficits in selective measures of academic abilities,language compreh ension,and planning and organizational skills suggest a negative impact of SDB on achievement and cognition.Stronger associations in preterm children suggest the importance of screening for snoring,a good predictor of cognitive function in this population.
