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2. Children Born Very or Extremely Preterm Transitioning to School: A Cross-Sectional Study Examining Predictors of School Readiness, School Adjustment, and Support Needs

Author

Amy E. Mitchell, Rebecca Armstrong, Cathy McBryde, Alina Morawska, Evren Etel, Elizabeth M. Hurrion, Tomomi McAuliffe, and Leanne Johnston

Abstract

The transition to school is a sensitive developmental period for young children. Although children born very/extremely preterm have increased risk of health and developmental concerns, predictors of their school readiness and adjustment remain largely unexamined. Parents of very/extremely preterm-born children (aged 3-7 years; pre-transition n = 114, post-transition n = 112) completed an online survey assessing their perceptions of children's school readiness (pre-transition) or adjustment (post-transition), support needs, child behaviour, parent distress, and parent confidence. Poorer school readiness and adjustment and greater needs for support correlated with child health/developmental condition/s; hyperactivity, peer problems, conduct problems, emotional symptoms, and less prosocial behaviour; and lower parent confidence. Using hierarchical linear regression, parent confidence emerged as the strongest common predictor of school readiness (pre-transition) and school adjustment (post-transition), followed by low hyperactivity, high parent education (tertiary), and no diagnosed child health/developmental condition/s. Results will be used to identify families needing support and develop tailored support strategies.

Published
2024
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4. SuPreme Study: a protocol to study the neuroprotective potential of sulfate among very/extremely preterm infants

Author

Catherine Morgan, Stefanie Hennig, Kristen Gibbons, Vicki Flenady, Sailesh Kumar, Pieter Koorts, Nadia Badawi, Roslyn N Boyd, Paul A Dawson, Elizabeth M Hurrion, Manbir Chauhan, and Francis Bowling

Subjects
Medicine
Abstract

Introduction Antenatal maternal magnesium sulfate (MgSO4) administration is a proven efficacious neuroprotective treatment reducing the risk of cerebral palsy (CP) among infants born preterm. Identification of the neuroprotective component with target plasma concentrations could lead to neonatal treatment with greater efficacy and accessibility.Methods and analysis This is a prospective observational cohort study, in three tertiary Australian centres. Participants are preterm infants, irrespective of antenatal MgSO4 exposure, born in 2013–2020 at 24+0 to 31+6 weeks gestation, and followed up to 2 years corrected age (CA) (to September 2023). 1595 participants are required (allowing for 17% deaths/loss to follow-up) to detect a clinically significant reduction (30% relative risk reduction) in CP when sulfate concentration at 7 days of age is 1 SD above the mean.A blood sample is collected on day 7 of age for plasma sulfate and magnesium measurement. In a subset of participants multiple blood and urine samples are collected for pharmacokinetic studies, between days 1–28, and in a further subset mother/infant blood is screened for genetic variants of sulfate transporter genes.The primary outcome is CP. Surviving infants are assessed for high risk of CP at 12–14 weeks CA according to Prechtl’s Method to assess General Movements. Follow-up at 2 years CA includes assessments for CP, cognitive, language and motor development, and social/behavioural difficulties.Multivariate analyses will examine the association between day 7 plasma sulfate/magnesium concentrations with adverse neurodevelopmental outcomes. A population pharmacokinetic model for sulfate in the preterm infant will be created using non-linear mixed-effects modelling.Ethics and dissemination The study has been approved by Mater Misericordiae Ltd Human Research Ethics Committee (HREC/14/MHS/188). Results will be disseminated in peer-reviewed journal publications, and provided to the funding bodies. Using consumer input, a summary will be prepared for participants and consumer groups.

Published
2023
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6. 'Low-normal' motor skills in infants at high risk for poor developmental outcomes: A prevalence and prognostic study

Author

Marcella Danks, Emma J. Flynn, Peter H. Gray, and Elizabeth M. Hurrion

Subjects
Child Development, Developmental Neuroscience, Motor Skills, Pediatrics, Perinatology and Child Health, Motor Disorders, Infant, Newborn, Prevalence, Humans, Infant, Birth Weight, Disabled Persons, Neurology (clinical), Prognosis
Abstract

To investigate the prevalence and prognostic value of 'low-normal' motor skills in infants at high-risk for poor developmental outcomes.Infants born extremely low-birthweight and extremely preterm discharged from neonatal intensive care between 2015 and 2018 completed the Alberta Infant Motor Scale (AIMS), Neuro-Sensory Motor Developmental Assessment (NSMDA) at corrected age 4, 8, and 12 months, and Griffiths Mental Development Scale at corrected age 12 months.Participating infants (n = 191) with a mean gestational age (95% confidence interval [CI]) of 26.80 weeks (26.60, 27.1) and mean birthweight (95% CI) of 869 grams (843, 895) included 45 (23.80%) infants small for gestational age. AIMS rated 50.32%, 35.37%, and 14.86% of infants within the 'low-normal' motor skills range (1-2 SD below the mean for age) at 4, 8, and 12 months respectively. Of the infants within the AIMS 'low-normal' skills range, 55.70%, 88.46%, and 59.10% were classified as having impairment by NSMDA at 4, 8, and 12 months respectively. Griffiths assessment at 12 months identified only 7.33% of infants with 'low-normal' skills and 3.33% with motor disability. Minimal motor impairment rating on the NSMDA at 4 or 8 months significantly predicted general development at 12 months.High-risk infants with 'low-normal' motor skills may warrant referral to early intervention as associated impairment represents increased risk for poorer general development outcomes.High prevalence of 'low-normal' motor skill exists in high-risk infants. Clinical motor assessment validly identifies infants with motor impairment. Minimal motor impairment in high-risk infants is prognostic of general development. High-risk infants with 'low-normal' motor skills may warrant early intervention. Griffiths Scales of Child Development, Third Edition assessment at 12-months age may under-identify motor difficulties.Investigar la prevalencia y el valor pronóstico de las habilidades motoras "normales bajas" en bebés con alto riesgo de trastornos del desarrollo. MÉTODO: Los bebés nacidos con un peso extremadamente bajo al nacer y extremadamente prematuros dados de alta de la unidad de cuidados intensivos neonatales entre 2015 y 2018 completaron la Escala motora infantil de Alberta (AIMS), Evaluación del desarrollo motor neurosensorial (NSMDA) a la edad corregida de 4, 8 y 12 meses. y la Escala de Desarrollo Mental de Griffiths a la edad corregida de 12 meses.Los lactantes participantes (n = 191) con una edad gestacional media (intervalo de confianza [IC] del 95 %) de 26,80 semanas (26,60, 27,1) y un peso al nacer medio (IC del 95 %) de 869 gramos (843, 895) incluyeron 45 (23,80 %) lactantes pequeños para la edad gestacional. La AIMS calificó al 50,32 %, 35,37 % y 14,86 % de los bebés dentro del rango de habilidades motoras "normal-baja" (1-2 DE por debajo de la media para la edad) a los 4, 8 y 12 meses, respectivamente. De los bebés dentro del rango de habilidades 'bajo-normal' de AIMS, el 55,70 %, el 88,46 % y el 59,10 % fueron clasificados como afectados por la NSMDA a los 4, 8 y 12 meses, respectivamente. La evaluación de Griffiths a los 12 meses identificó solo el 7,33 % de los bebés con habilidades "normales bajas" y el 3,33 % con discapacidad motora. La calificación de deterioro motor mínimo en la NSMDA a los 4 u 8 meses predijo significativamente el desarrollo general a los 12 meses. INTERPRETACIÓN: Los bebés de alto riesgo con habilidades motoras "normales-bajas" pueden justificar la derivación a una intervención temprana, ya que el deterioro asociado representa un mayor riesgo de trastornos del desarrollo general más deficientes.HABILIDADES MOTORAS "ABAIXO-DO-NORMAL" EM BEBÊS COM ALTO RISCO PARA UM POBRE DESENVOLVIMENTO: UM ESTUDO DE PREVALÊNCIA E PROGNÓSTICO: OBJETIVO: Investigar a prevalência e o valor prognóstico de habilidades motoras "abaixo-do-normal" em bebês de alto risco para pobre desenvolvimento. MÉTODO: Bebês nascidos de extremo baixo peso ao nascer e extremamente prematuros que receberam alta da terapia intensiva neonatal entre 2015 e 2018 e completaram a Alberta Infant Motor Scale (AIMS), Neuro-Sensory Motor Developmental Assessment (NSMDA) na idade corrigida de 4, 8 e 12 meses, e Griffiths Mental Development Scale aos 12 meses de idade corrigida. RESULTADOS: Participaram 191 bebês com idade gestacional média (intervalo de confiança de 95% [IC]) de 26,80 semanas (26,60; 27,1) e peso médio ao nascer (IC 95%) de 869 gramas (843, 895), dentre estes 45 (23,80%) lactentes eram pequenos para a idade gestacional. A AIMS pontuou 50,32%, 35,37% e 14,86% dos bebês dentro da faixa de habilidades motoras "abaixo-do-normal" (1-2 DP abaixo da média para a idade) aos 4, 8 e 12 meses, respectivamente. Dos bebês dentro da faixa de habilidades "abaixo-do-normal" da AIMS, 55,70%, 88,46% e 59,10% foram classificados como tendo prejuízo pelo NSMDA aos 4, 8 e 12 meses, respectivamente. A avaliação de Griffiths aos 12 meses identificou apenas 7,33% dos bebês com habilidades "abaixo-do-normal" e 3,33% com deficiência motora. A classificação de disfunção motora mínima no NSMDA em 4 ou 8 meses previu significativamente o desenvolvimento geral em 12 meses. INTERPRETAÇÃO: Bebês de alto risco com habilidades motoras "abaixo-do-normal" podem justificar o encaminhamento para intervenção precoce, pois o comprometimento associado representa um risco aumentado para desfechos pobres no desenvolvimento geral.

Published
2022

7. Childhood Pulmonary Alveolar Proteinosis

Author

Richard K. Firmin, Elizabeth M. Hurrion, and Pearson Ga

Subjects
Pulmonary and Respiratory Medicine, Resuscitation, medicine.medical_specialty, medicine.diagnostic_test, Membrane oxygenator, business.industry, medicine.medical_treatment, Therapeutic irrigation, Critical Care and Intensive Care Medicine, medicine.disease, law.invention, Surgery, Bronchoalveolar lavage, medicine.anatomical_structure, law, Anesthesia, Cardiopulmonary bypass, Extracorporeal membrane oxygenation, Medicine, Pulmonary alveolus, Cardiology and Cardiovascular Medicine, business, Pulmonary alveolar proteinosis
Abstract

Extracorporeal Membrane Oxygenation With Total Cardiopulmonary Support During Bronchopulmonary Lavage Elizabeth M. Hurrion, M.B., Ch.B.; Gale A. Pearson, M.D.; and Richard K. Firmin, M.D. Partial cardiopulmonary bypass with extracorporeal membrane oxygenation to allow bilateral bronchopulmonary lavage in pulmonary alveolar proteinosis has been described. However, this technique is complicated by a very low arterial Po 2 and cardiovascular embarrassment. Total cardiopulmonary support avoids these problems and was successfully used in a 2½-year-old girl.

Published
1994
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8. Visual search, perception, and visual-motor skill in 'healthy' children born at 27-32 weeks' gestation

Author

Nigel Foreman, Elena A. Sergienko, Catrin Minshell, Elizabeth M. Hurrion, and Alistair R. Fielder

Subjects
Male, Volition, medicine.medical_specialty, Visual perception, genetic structures, media_common.quotation_subject, Experimental and Cognitive Psychology, Context (language use), Audiology, Neuropsychological Tests, Developmental psychology, Child Development, Perception, Perceptual Closure, Developmental and Educational Psychology, Cognitive development, medicine, Reaction Time, Humans, Attention, Child, media_common, Retrospective Studies, Psychomotor learning, Visual search, Analysis of Variance, Infant, Newborn, Cognition, eye diseases, Form Perception, El Niño, Visual Perception, Female, Psychology, Perceptual Masking, Infant, Premature, Psychomotor Performance
Abstract

Visual-perceptual, attentional, and visual-motor skills were examined in a group of 16 school-age children, born at 27-32 gestational weeks, who had performed normally on pediatric screening tests. Compared with 16 matched full-term controls, the preterms performed poorly on only two measures: they took longer to point to the missing arc of an annulus displayed on a computer screen and failed to find targets more often in a complex visual search task. They showed no deficits on tests of visual form extraction and closure. These data suggest that in the absence of any disability that is clinically detectable, prematurity results in a cluster of small but significant visual-motor impairments that persist into middle childhood. These relate to the maintenance of attention and visual-motor coordination, though visual form perception is not measurably affected. The results are discussed in the context of current neurobiological models of visual system organization.

Published
1997

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