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Background. General movement assessment (GMA) is an assessment tool with high predictive validity for neurodevelopmental outcomes in preterm infants. Information available describing the trajectory of general movements (GMs) in high-risk preterm-born infants and the use thereof in low- and middle-income countries is limited. Objective. To describe the trajectories of GMs from birth until 12 - 14 weeks' corrected age, and determine the association of known perinatal risk factors on GM trajectories in very low-birthweight and extremely low-birthweight preterm infants. Methods. This was a longitudinal, prospective cohort study with 119 preterm infants born at <33 weeks' gestation and with a birthweight <1 500 g. GMs were recorded at four key age periods: 1 - 2 weeks after birth to 33 weeks post menstrual age (PMA); 34 - 37 weeks PMA; term equivalent age (TEA); and 12 - 14 weeks corrected age. Detailed perinatal data were collected. Results. A total of 300 GMAs were conducted, 157 during the preterm age, 55 during TEA and 88 at 12 - 14 weeks corrected age. At <33 weeks PMA, 96% of GMs were abnormal and 4% normal. At 34 - 37 weeks PMA, 89% of GMs were abnormal and 11% normal. All GMs recorded at term equivalent age were abnormal. At 12 - 14 weeks corrected age, 7% of GMs were abnormal and 93% normal. Conclusion. GMs were predominantly abnormal prior to term with a significant decrease in abnormality at 12 - 14 weeks corrected age. Lower birthweight and lower PMA were associated with increased odds for abnormal GMs. In a resource-constrained environment, observing GMs at 12 - 14 weeks corrected age (during the fidgety period) is a time- and cost-effective method to determine the risk for adverse neurodevelopment. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study is to describe the 30-day mortality, neurodevelopmental outcome and composite outcome (mortality or abnormal neurodevelopmental outcome) of neonates with necrotizing enterocolitis (NEC), requiring neonatal intensive care (NICU) admission, in a resource-restricted environment.Methods: All neonates admitted to Tygerberg Hospital, NICU, with a presumptive diagnosis of NEC Bell stage IIB or more, over a 5-year period, were included.Results: One hundred and thirty-five neonates were included with a mean gestational age of 29 ± 2.7 weeks and mean birth weight of 1185 g ± 446 g. The 30-day mortality was 52%, neurodevelopment abnormalities occurred in 35% of survivors and adverse composite outcome in 63%. The 30-day mortality and adverse composite outcome risk were increased by small for gestational age, shock, metabolic acidosis, inotrope requirement and first feed >9 days after surgery.Conclusion: In resource-restricted environments, mortality and abnormal neurodevelopmental outcome of neonates with NEC, remain high. However, outcomes are comparable with international literature. Neonates with NEC, requiring NICU admission and surgery, require neurodevelopmental follow-up. [ABSTRACT FROM AUTHOR]

Objective: To asses the relation between echogenicity changes in the fetal brain and neurodevelopmental outcome until 6 years of age. Methods: Fetuses ( n = 124) from pregnancies affected by hypertensive disorders ( n = 64) or preterm labor ( n = 60) at risk for preterm birth (26-34 weeks gestation) were studied. Moderate echogenicity changes (periventricular grade IB, II; intraventricular grade II-III; local basal ganglia/thalami) in the fetal and neonatal brain were related to neurological outcome and Griffiths mental developmental scales quotients at 1, 2 and 6 years. Multiple regression analysis tested the influence of moderate echogenicity changes and perinatal clinical characteristics on composite outcome (death or abnormal neurodevelopment). Results: Moderate echogenicity changes were present in 37/124 (30%) fetuses. Median gestational age and weight at birth were respectively 31 weeks (range 26-43), 1314 g (range 550-4330), mortality was 19%, follow-up loss 10%. Composite outcome was abnormal in 47/124 (38%). Fetal and neonatal moderate intraventricular echodensities were related to cerebral palsy at 6 years ( p < 0.04). In the multiple regression analysis only gestational age was related to composite outcome ( p = 0.005). Conclusions: Moderate intraventricular echodensities in the fetal brain related to cerebral palsy at 6 years of age. Gestational age at birth was the main predictor of abnormal composite outcome. [ABSTRACT FROM AUTHOR]

Umbilical artery Doppler flow velocity waveform studies were performed over a period of 4 y on 242 women with severe pre-eclampsia before 34 wk gestation. Sixty-eight (28%) had absent end-diastolic umbilical artery Doppler flow velocities. One hundred and ninety-three infants survived to hospital discharge and were followed at 6-monthly intervals until 48 mo of age. The mean corrected developmental quotient was 94 +/- 8 at 24 mo of age and 87 +/- 9 at 48 mo. Ninety-two percent of the infants had a developmental quotient of >80 at 24 mo and 72% at 48 mo of age. This decline is thought to be due to the impact of social circumstances. There were no differences between the developmental quotients of the infants with normal and those with absent end-diastolic umbilical artery Doppler flow velocities at either 24 or 48 mo of age. At 24 mo of age, infants with absent end-diastolic umbilical artery Doppler flow velocities scored lower in the Performance subscale test (p = 0.03). The developmental quotients of infants from poorer socioeconomic backgrounds were significantly lower than those living in more privileged circumstances. At 48 mo, 153 (97%) of the children presented with normal gross motor development. Four infants had cerebral palsy. No differences were noted in the motor outcomes between the infants of women with normal umbilical artery waveforms and those with absent end-diastolic umbilical artery Doppler flow velocities. [ABSTRACT FROM AUTHOR]

Objective: To determine the outcome at 1 year of age of a group of very-low-birth-weight (VLBW) infants, from urban and rural communities, ventilated at Tygerberg Hospital, W. Cape., Study Design: Prospective descriptive study in which the prevalence of bronchopulmonary dysplasia (BPD), sensorineural deafness, intraventricular haemorrhage (IVH), retinopathy of prematurity (ROP) and abnormal motor developmental outcomes were determined in 153 ventilated VLBW infants from rural and urban areas. Of these, 69% were from lower socio-economic backgrounds., Main Outcome Measures: Attrition rates for rural and urban babies, BPD, ROP, IVH and abnormal motor development., Study Population and Setting: All ventilated VLBW infants discharged from the neonatal intensive care unit at Tygerberg Hospital over a 1-year period were followed up at 3-monthly intervals for 12 months., Results: BPD was diagnosed in 19% of the babies, with significantly more babies with birth weights under 1,000 g and gestational ages under 28 weeks having BPD. Of the babies with BPD, 25% had abnormal motor development at 1 year of age. Seven per cent of the babies had grade 3 or 4 ROP and 2.6% had sensorineural hearing loss. One hundred and seventeen (79%) of the infants attended the follow-up clinic until 12 months of age (corrected for prematurity). There were no significant differences in the number of babies followed up from rural or urban areas. Fourteen (11.9%) of the babies had abnormal motor development. A disturbing finding was that so many babies had spastic quadriplegia (8; 57%) versus diplegia (6; 43%). The incidence of abnormal motor development in the babies from the rural areas and in those with birth weights under 1,000 g from rural areas was high--a further cause for concern., Conclusion: The prevalence of the major complications associated with ventilated VLBW infants correlated well with those reported for similar infants from First-World countries. The poor motor developmental outcome of the babies from rural areas with birth weights under 1,000 g and high attrition rates for infants with serious complications such as BPD, IVH and ROP are distressing.