Transitions on and off AFDC: implications for parenting and children's cognitive development.

The goal of current national and state legislation on welfare reform is to decrease the number of people who are dependent on public assistance, most of whom are mothers and their young children. Mothers' patterns of welfare receipt in the 3 years following the birth of a child were examined vis-à-vis their associations with maternal emotional distress (General Health Questionnaire), provision of learning experiences (Home Observation of the Measurement of the Environment), parenting behavior, and the child's cognitive test score (Stanford-Binet) in the third year of life. The data set was the Infant Health and Development Program, an eight-site randomized clinical trial designed to test the efficacy of educational and family support services in reducing developmental delays in low-birthweight, preterm infants (N = 833).

Patterns of service use in preschool children: correlates, consequences, and the role of early intervention.

This article explores service use broadly by examining the mix of educational, health, and psychosocial services that preschool children received in the fifth year of life. The sample included 869 children who participated in the Infant Health and Development Program, an early intervention program designed to evaluate the efficacy of a comprehensive early intervention for low-birth-weight, premature infants during the first 3 years of life and who were followed until age 5. Cluster analyses of services at age 5 yielded 4 service groups--basic health only (doctor visits; n = 114); basic health and educational services (doctor visits and school/preschool; n = 444); basic health, educational, and psychosocial services (or multiple services; doctor visits, school/preschool, and psychosocial services; n = 129); and specialized health and educational services (doctor visits, school/preschool, emergency room visits and special medical visits [ear and/or eye examinations]; n = 182).

Evaluation of a long-chain polyunsaturated fatty acid supplemented formula on growth, tolerance, and plasma lipids in preterm infants up to 48 weeks postconceptional age.

Background: The last trimester of pregnancy is a period of rapid accretion of long-chain polyunsaturated fatty acids, both in the central nervous system and the body as a whole. Human milk contains these fatty acids, whereas some preterm infant formulas do not. Infants fed formulas without these fatty acids have lower plasma and erythrocyte concentrations than infants fed human milk.

The contribution of neighborhood and family income to developmental test scores over the first three years of life.

The effects of neighborhood and family income and family risk factors on developmental test scores at ages 1 through 3 are examined using a subsample (N = 347) from the Infant Health and Development Program. Beneficial effects of low numbers of risks were found for scores at ages 1 through 3. Family poverty was associated with lower scores at ages 2 and 3.

Behavioral outcomes in low birth weight infants.

Low birth weight infants are at increased risk for behavioral and emotional problems. The Infant Health and Development Program was designed to evaluate the efficacy of intense pediatric and family support on reducing developmental and behavioral problems in low birth weight, premature infants. The major findings of this and other studies are presented in this article.

Health care use of 3-year-old low birth weight premature children: effects of family and neighborhood poverty.

Objective: The objective of this study was to examine the effect of family and neighborhood income on health care use of young children born prematurely and of low birth weight (N = 619).

Design: A birth cohort was enrolled in a clinical randomized trial of early childhood educational and family services.

Settings/participants: Infant Health and Development Program provided a sample of low birth weight premature infants stratified by clinical site, birth weight, and treatment group.

The effectiveness of early intervention: examining risk factors and pathways to enhanced development.

In this paper we examine the effectiveness of early intervention, especially vis-à-vis (a) child and family risk factors and (b) the pathways to enhanced child and family development. To address these issues we draw on findings from the Infant Health and Development Program (IHDP) for low-birth-weight premature infants. The data we present reveal the considerable effectiveness of the IHDP intervention in enhancing several aspects of early and later child and family development.

Patterns of cognitive development in very low birth weight children during the first six years of life.

Background: Cognitive development in very low birth weight (VLBW, < or = 1500 g) infants typically has been reported based on mean endpoints in cross-sectional studies. These overall group means mask individual patterns of cognitive development. Given the heterogeneity of VLBW infants, it is important to identify individual patterns of development and the factors associated with the different patterns.

Results at age 8 years of early intervention for low-birth-weight premature infants. The Infant Health and Development Program.

Objective: To reevaluate at age 8 years children who had participated during the first 3 years of life in a randomized clinical trial of special services for low-birthweight (LBW) premature infants.

Design: Follow-up of a randomized controlled trial of premature infants (< or = 37 weeks' gestation), stratified by 2 LBW groups (lighter [< or = 2000 g] and heavier [2001-2500 g]) and divided into intervention (n=377) and follow-up only (n=608) groups.

Setting: Eight sites serving diverse populations.

Cognitive and neurologic development of the premature, small for gestational age infant through age 6: comparison by birth weight and gestational age.

Objective: To compare the neurologic and cognitive outcomes of 129 premature small for gestational age (SGA) infants with 300 premature appropriate for gestational age (AGA) infants through 6 years of age.

Design: Infants born at < or = 37 weeks gestational age and < or = 2500 g with birth weight 2 standard deviations or more below the mean birth weight for gestational age were categorized as SGA. Cognitive and neurologic outcomes of SGA and AGA prematures at 1, 2, 3, and 5 and/or 6 years of age were compared when the infants were stratified by gestational age in 2-week intervals or by birth weight in 500-g intervals.

Early intervention for low-birth-weight premature infants: what can we achieve?

Low-birth-weight (LBW) premature infants are at increased risk for abnormal development. It is unclear whether intervention programs designed to prevent the disabilities in preterm children are efficacious. This paper reviews the settings in which interventions take place (e.

Relations between infant neurobehavioral performance and cognitive outcome in very low birth weight preterm infants.

The predictive utility of three aspects of neonatal neurobehavioral performance was examined in 144 very low birth weight (< 1500 g) preterms who were followed until 6 years of age. Visual-following and auditory-orienting composites derived from the Einstein Neonatal Neurobehavioral Assessment Scale were modestly related to the Mental Developmental Index (MDI) and IQ scores at several ages, whereas the active motility composite was only related to MDI scores at 1 year of age (corrected). Infants who showed deviant performance on both visual following and auditory orienting composites had significantly lower cognitive test scores at 1 and 6 years of age and were more likely to be classified as subaverage at 6 years of age (IQ < 85).

Preventive interventions with low birth weight premature infants: an evaluation of their success.

The outcome literature on low birthweight (LBW) premature children indicates that they are at risk for a variety of neurodevelopmental impairments throughout childhood. To prevent such disabilities, numerous interventions have been initiated with LBW children. Nineteen intervention programs designed for LBW preterms that have published study results dating from 1971 are reviewed.

Early intervention in low-birth-weight premature infants. Results through age 5 years from the Infant Health and Development Program.

Objective: To evaluate the persistence of effects on health and development at age 5 years of the Infant Health and Development Program, an early childhood intervention that was provided to low-birth-weight (LBW) premature infants from neonatal discharge through age 3 years.

Design: Randomized, controlled, multicenter trial, stratified by two LBW groups: lighter (< or = 2000 g) and heavier (2001 to 2500 g).

Setting: Eight socioeconomically heterogeneous clinical sites.

Effects of in utero drug exposure on children's development. Review and recommendations.

Effects of in utero drug exposure on pregnancy outcome, infant development, and preschool functioning are reviewed. Six possible mechanisms underlying possible negative outcomes seen in children exposed to drugs in utero are considered. Recommendations and opportunities for future research focus on process-oriented assessments, methodological and procedural issues, research design, and interventions.

Early educational intervention for very low birth weight infants: results from the Infant Health and Development Program.

Objective: To examine the effect of early educational intervention after discharge from the hospital on the health and developmental status of very low birth weight (< or = 1500 gm) infants.

Design: Randomized, controlled trial, with post hoc analysis.

Setting: Eight sites, heterogeneous for sociodemographic and health care use.

A neonatal preventive intervention study: Issues of recruitment and retention.

Intervention to prevent negative mental health outcomes in families of ill and premature newborns is an important part of neonatal care. This study addresses the factors which influence participation in a parent support group for parents of ill and premature newborns. Demographic, social support, and infant health data were examined to determine how support group participants and nonparticipants differed.

Otitis media and language development at 1 year of age.

The effect of otitis media on emerging language was examined in a group of 1-year-olds. Based on pneumatic otoscopy, 15 babies were considered to be free of otitis media in both ears at 80% or more of their first year medical visits (otitis free) and 12 infants had bilaterally positive otoscopy results at 30% or more of their visits (otitis positive). Outcome measures at 1 year included the Bayley Scales of Infant Development (Bayley, 1969) and the Sequenced Inventory of Communication Development (SICD; Hedrick, Prather, & Tobin, 1984) Receptive and Expressive scales.

Otitis media in neonatal intensive care unit graduates: a 1-year prospective study.

A group of 46 high-risk infants (graduates of a neonatal intensive care unit) and 19 full-term infants were observed prospectively for middle ear status beginning at 40 weeks' postconceptional age. All infants were born to families living in low socioeconomic urban neighborhoods. Pneumootoscopy was used to determine the presence or absence of middle ear effusion during periodic medical and nonmedical visits throughout a 1-year period.

Information processing in seven-month-old infants as a function of risk status.

7-month-old full-terms and high-risk preterms (less than 1,500 grams at birth) were compared on problems of visual recognition memory and tactual-to-visual cross-modal transfer. On the visual problems, preterm infants showed significantly less differential attentiveness to novelty than full-terms. They also required longer exposure times during visual familiarization, primarily because of longer pauses between fixations.

A prospective study of otitis media in infants born at very-low birthweight.

Forty-six infants born at very-low birthweight were followed prospectively for a one-year period after their discharge from a neonatal intensive care unit. Pneumatic otoscopy was used to diagnose otitis media at periodic visits to a medical/developmental follow-up program. Twenty-one normal, full-term infants routinely cared for in a well-baby nursery served as control subjects and were followed similarly for the same time period.

Otitis media, auditory sensitivity, and language outcomes at one year.

The relationship among otitis media, auditory sensitivity, and emerging language was examined in a group of 1-year-old children who were prospectively followed since birth. Pneumatic otoscopy was used to document the otologic status of the children's ears at each medical visit. There were 13 babies with normal ratings in each ear at 80% more of their visits (designated as "otitis free") and 12 babies with bilaterally positive otoscopy results at 30% or more of their first year visits (designated "otitis positive").

A simple estimate of glomerular filtration rate in low birth weight infants during the first year of life: noninvasive assessment of body composition and growth.

The management of the preterm infant often requires rapid assessment of glomerular filtration rate (GFR). We sought to develop a screening test using GFR = kL/Pcr, where GFR is expressed as ml/min/1.73 m2, L is body length in centimeters, Pcr is plasma creatinine concentration, and k is a constant that depends on muscle mass.