Adolescents born prematurely with isolated grade 2 haemorrhage in the early 1990s face increased risks of learning challenges.

Aim: To compare the impact of low-grade haemorrhage on neurocognitive function in 16-year-old adolescents born preterm, by grade of intraventricular haemorrhage, and term controls.

Methods: We evaluated 338 preterm adolescents (birth weight 600-1250 g) for intelligence, executive function and memory tasks. Eleven had grade 3-4 haemorrhage, 44 had grade 2, 31 had grade 1, and 251 had no haemorrhage.

Mid-gestational maternal free thyroxine concentration and offspring neurocognitive development at age two years.

Context: Lower neurocognitive development scores at age 2 yr have been reported in association with euthyroid hypothyroxinemia during early pregnancy.

Objective: The objective of this study was to further explore this association with euthyroid hypothyroxinemia during early pregnancy.

Design: This was an observational, nested case-control study.

Evidence for catch-up in cognition and receptive vocabulary among adolescents born very preterm.

Background: Very preterm adolescents display persistent deficits in neuropsychological functions.

Objective: To compare cognitive and language outcomes at 16 years and cognitive and receptive vocabulary trajectories throughout school years between very preterm and term children and to determine child and family factors associated with better developmental trajectories.

Design And Methods: At 8, 12, and 16 years, 322 very preterm children with birth weights of 1250 g or less and 41 term children had cognitive and language testing.

Executive and memory function in adolescents born very preterm.

Background: Many preterm children display school difficulties, which may be mediated by impairment in executive function and memory.

Objective: To evaluate executive and memory function among adolescents born preterm compared with term controls at 16 years.

Methods: A total of 337 of 437 (77%) adolescents born in 1989 to 1992 with a birth weight < 1250 g and 102 term controls were assessed with a battery of executive function and memory tasks.

Early predictors of hypertension in prematurely born adolescents.

Objective:  To assess the blood pressure of former preterm and term matched adolescent controls and to identify risk factors associated with blood pressure at 16 years.

Design:   Observational cohort study. Secondary analysis of a randomized clinical trial.

Maternal obesity, gestational hypertension, and preterm delivery.

Objective: To study maternal obesity as a risk factor for preterm delivery.

Methods: Maine State Birth Records Database from 1996 through 2006 was evaluated to investigate obese pregnant women compared with normal weight women regarding risk for preterm delivery. Multiple risk factors and outcomes were studied in univariable and multivariable models.

Trajectories of receptive language development from 3 to 12 years of age for very preterm children.

Objectives: The goal was to examine whether indomethacin use, gender, neonatal, and sociodemographic factors predict patterns of receptive language development from 3 to 12 years of age in preterm children.

Methods: A total of 355 children born in 1989-1992 with birth weights of 600 to 1250 g were evaluated at 3, 4.5, 6, 8, and 12 years with the Peabody Picture Vocabulary Test-Revised.

Maternal obesity and markers of inflammation in pregnancy.

Objectives: To evaluate whether obesity is associated with changes in pro-inflammatory and immunomodulatory cytokines in pregnancy.

Methods: We performed a cross-sectional study using maternal serum from the early second trimester to examine biomarkers associated with inflammation in relation to maternal body mass index (n=80 total).

Results: Leptin and high sensitivity C-reactive protein were significantly different between groups and increased with increasing body mass index.

Lasting effects of preterm birth and neonatal brain hemorrhage at 12 years of age.

Objectives: Our goals were to compare cognitive, language, behavioral, and educational outcomes of preterm children to term controls and to evaluate the impact of neonatal brain injury, indomethacin, and environmental risk factors on intellectual function at 12 years of age.

Methods: A total of 375 children born in 1989-1992 with birth weights of 600 to 1250 g enrolled in the Indomethacin Intraventricular Hemorrhage Prevention Trial and 111 controls were evaluated. Neuropsychometric testing, neurologic examination, and interviews on educational needs were completed.

Cortical recruitment patterns in children born prematurely compared with control subjects during a passive listening functional magnetic resonance imaging task.

Objectives: To use functional magnetic resonance imaging (fMRI) to test the hypothesis that subjects who were born prematurely develop alternative systems for processing language.

Study Design: Subjects who were born prematurely (n = 14; 600-1250 g birthweight) without neonatal brain injury and 10 matched term control subjects were examined with a fMRI passive listening task of language, the Clinical Evaluation of Language Fundamentals (CELF) and portions of the Comprehensive Test of Phonological Processing (CTOPP). The fMRI task was evaluated for both phonologic and semantic processing.

A functional magnetic resonance imaging study of the long-term influences of early indomethacin exposure on language processing in the brains of prematurely born children.

Background: Previous studies have demonstrated that indomethacin lowers the incidence and decreases the severity of intraventricular hemorrhage, as well as improves the cognitive outcome, in prematurely born male infants.

Objective: The purpose of this work was to use functional magnetic resonance imaging to test the hypothesis that neonatal indomethacin treatment would differentially affect brain activation across genders in school-aged, prematurely born children during performance of a language task.

Methods: Forty-seven prematurely born children (600-1250-g birth weight) and 24 matched term control subjects were evaluated using a functional magnetic resonance imaging passive language task and neurodevelopmental assessments that included the Wechsler Intelligence Scale for Children-III and the Peabody Picture Vocabulary Test-Revised.

Seizures, syncope, or breath-holding presenting to the pediatric neurologist--when is the etiology a life-threatening arrhythmia?

Using case reports from their own experience and in the literature the authors illustrate the difficulty in distinguishing non-life threatening causes, including epilepsy, from a serious cardiac arrythmia when evaluating children with paroxysmal events. Focusing on long QT syndrome, they suggest an approach for the pediatric neurologist that utilizes the electrocardiogram recorded during the electroencephalogram--direct measurement of the corrected QT interval. This approach requires knowledge of the distribution of the corrected QT interval in long QT syndrome.

Telegenetics in Maine: Successful clinical and educational service delivery model developed from a 3-year pilot project.

Purpose: The goal of this 3-year pilot project was to increase accessibility to genetics educational and clinical services in Maine.

Methods: Southern Maine Genetics Services, Foundation for Blood Research in collaboration with Maine Telemedicine Services established telemedicine capacity to link with rural health care centers located in Northern, Central, and Southern Maine and public health nursing statewide for the provision of genetics clinical and educational services. Core partners included a rural family practice residency program, a rural pediatric practice in northern Maine, and public health nurses statewide.

Prevention of intraventricular hemorrhage by indomethacin in male preterm infants.

Our multicenter Indomethacin Intraventricular Hemorrhage (IVH) Prevention Trial demonstrated a reduction of IVH in preterm infants. Analysis of our cohort by sex showed indomethacin halved the incidence of IVH, eliminated parenchymal hemorrhage, and was associated with higher verbal scores at 3 to 8 years in boys.

Neonatal intensive care neurology.

The pediatric neurologist's role in the neonatal intensive care unit is described in four clinical settings: (1) assessment of outcome in neonatal encephalopathy, (2) treatment of seizures in full-term infants, (3) assessment and treatment of intraventricular hemorrhage with posthemorrhagic hydrocephalus, and (4) assessment of outcome in preterm infants. Emphasis is placed on the evidenced-based information available in these settings and on new therapies on the horizon. Using evidence-based information, the pediatric neurologist can accurately assess prognosis in the neonatal period, and this can provide the basis for a rational assessment of newer therapies in neonatal intensive care.

An evidence-based approach to predicting low IQ in very preterm infants from the neurological examination: outcome data from the indomethacin Indomethacin Intraventricular Hemorrhage Prevention Trial.

We evaluated whether the degree of cerebral palsy (CP) at age 3 in very preterm children is predictive of full-scale intelligence quotient (FSIQ) <70 at age 8 by calculating likelihood ratios (LRs) for findings on the neurologic examination. Data from the follow-up phase of the Indomethacin Intraventricular Hemorrhage Prevention Trial, which includes periodic neurologic examination and neuropsychometric testing, were used. Information was available on 366 of 440 (83%) children with birth weight of 600 to 1250 g who survived.

Perceptual organization based upon spatial relationships in Alzheimer's disease.

Alzheimer's disease (AD) is often accompanied by impaired object recognition, thereby reducing the ability to recognize common objects and familiar faces. Impaired recognition may stem from decreased efficacy in integrating visual information. Studies of perceptual abnormalities in AD indicate an impairment in organizing elements of the visual scene, thereby confusing components of individual forms.

School-age outcomes of very low birth weight infants in the indomethacin intraventricular hemorrhage prevention trial.

Objective: The cohort consisted of 328 very low birth weight infants (600-1250 g birth weight) who were enrolled in the low-dose prophylactic indomethacin prevention trial and were intraventricular hemorrhage (IVH) negative at 6 postnatal hours. The objective was to determine the effects of both IVH and indomethacin on cognitive, language, and achievement performance at 8 years of age.

Methods: The cohort was divided into 4 subgroups for analysis: indomethacin plus IVH, indomethacin no IVH, saline plus IVH, and saline with no IVH.

Change in cognitive function over time in very low-birth-weight infants.

Context: Preterm very low-birth-weight (VLBW) infants have a high prevalence of neurodevelopmental disability when evaluated during the first several years of life. However, recent experimental data suggest that the developing brain may recover from or compensate for injury.

Objective: To determine if there is cognitive improvement throughout early and middle childhood following VLBW birth.