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This study examined associations of a caregiver-based diagnosis of attention deficit hyperactivity disorder (ADHD) in kindergarten with early learning progress in 139 extremely preterm/extremely low birth weight (EPT/ELBW, gestational age

OBJECTIVE The study was designed to investigate the effect of extreme prematurity on growth in academic achievement across the early school years and the validity of kindergarten neuropsychological skills as predictors of achievement. METHOD A 2001-2003 birth cohort of 145 extremely preterm/extremely low birth weight (EPT/ELBW) children from a single medical center, along with 111 normal birth weight (NBW) classmate controls, were recruited during their first year in kindergarten and followed annually across the next 2 years in school. Mixed model analysis was conducted to compare the groups on growth in achievement across years and examine kindergarten neuropsychological skills as predictors of growth. RESULTS The EPT/ELBW group scored significantly below NBW controls on all achievement tests across years and had higher rates of special education placement and grade repetition. Despite limited catch-up of the EPT/ELBW group to the NBW controls in spelling, group differences were generally stable. Differences in spelling and mathematics achievement remained significant when controlling for global intelligence or excluding children who had intellectual or neurosensory impairments or repeated a grade. Higher scores on kindergarten tests of multiple neuropsychological ability domains predicted higher achievement levels and steeper growth in achievement. CONCLUSIONS The findings document persistent academic weaknesses in EPT/ELBW children across the early school years. Results point to the need for preschool interventions to enhance academic readiness and suggest that neuropsychological skills assessed in kindergarten are useful in identifying individual differences in early learning progress. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Background Adult congenital heart disease (ACHD) patients have high rates of untreated depression and anxiety disorders. We evaluated associations among self-reported depression symptoms and alcohol/smoking tobacco use. Methods From 2009 to 2013, 202 ACHD patients (45% male) completed questionnaires on depressive symptoms, anxiety symptoms, and substance use as part of routine clinical care. Data were collected by retrospective chart review. Results Mean age was 31 ± 10 years, 21% reported often feeling depressed and 33% reported feeling nervous or anxious. Sixty-one percent of patients reported some alcohol intake; 25% reported current or previous smoking tobacco use. Patients with depressive symptoms were 3× as likely to report drinking alcohol (OR 2.89; 95% CI 1.29–6.5) and 5× more likely to report smoking tobacco use (OR 5.17; 95% CI 1.49–17.87). Fourteen percent of patients were prescribed antidepressant/antianxiety medications; 43% of patients on medication reported depressive symptoms. In patients reporting symptoms, those who consumed alcohol were less likely to be on antidepressant/antianxiety medications (21%) than those who did not consume alcohol (56%). Conclusion Self-reported depressive symptoms are associated with increased alcohol and smoking tobacco use by ACHD patients. Alcohol use may be a means of self-medicating for untreated depression, but further investigation is needed. Risk factors, including depressive symptoms and substance use, should be routinely assessed and addressed in ACHD patients.

With advancements in medical care, many women with complex congenital heart disease (CHD) are now living into adulthood and childbearing years. The strains of pregnancy and parturition can be dangerous in such patients, and careful interdisciplinary plans must be made to optimize maternal and fetal health through this process. Several large studies have been published regarding risk prediction and medical management of pregnancy in complex CHD, though few case studies detailing clinical care plans have been published. The objective of this report is to describe the process of developing a detailed pregnancy and delivery care plan for three women with complex CHD, including perspectives from the multidisciplinary specialists involved in the process. This article demonstrates that collaboration between specialists in the fields of cardiology, anesthesiology, high-risk obstetrics, maternal fetal medicine, and neonatology results in clinically successful individualized treatment plans for the management of pregnancy in complex CHD. Multidisciplinary collaboration is a crucial element in the management of pregnancy in complex CHD. We provide a template used in three cases which can serve as a model for the design of future care plans.

To examine the prevalence of behavior disorders in a 2001-2003 birth cohort of extremely preterm/extremely low birth weight (EPT/ELBW,28 weeks gestational age or1000 g) children in kindergarten.We compared 148 EPT/ELBW children with 111 term-born normal birth weight classmate controls on reports of psychiatric symptoms obtained from parent interview (Children's Interview for Psychiatric Syndromes-Parent Form [P-ChIPS]), parent and teacher ratings of behavior (Child Behavior Checklist, Teacher's Report Form, and Behavior Rating Inventory of Executive Function), and teacher ratings of social functioning (School Social Behavior Scales, second edition). Associations of behavior disorders with global cognitive ability and tests of executive function were also examined within the EPT/ELBW group.Rates of attention-deficit/hyperactivity disorder combined on psychiatric interview were about twice as high for the EPT/ELBW group than for the normal birth weight group, odds ratio (95% confidence interval) = 2.50 (1.34, 4.68), p = .004. The EPT/ELBW group also had much higher rates of teacher-identified disorders in attention, behavior self-regulation, and social functioning, with odds ratios (95% confidence intervals) ranging from 3.35 (1.64, 6.83) to 18.03 (4.12, 78.94), all p values.01. Attention-deficit/hyperactivity disorder and impaired behavior self-regulation were associated with deficits on tests of executive function but not with global cognitive impairment.The findings document increased rates of disorders in attention, behavior self-regulation, and socialization in EPT/ELBW children and suggest that deficits on tests of executive function are associated with some of these disorders. Early identification and intervention for these disorders are needed to promote early adjustment to school and facilitate learning progress.

Our objectives were to examine cognitive outcomes for extremely preterm/extremely low birth weight (EPT/ELBW, gestational age p< .001. Deficits on measures of executive function and motor and perceptual-motor abilities were found even when controlling for acquired verbal knowledge. Neonatal risk factors, early neurodevelopmental impairment, and lower SES were associated with higher rates of deficits within the EPT/ELBW group. The findings document both global and selective cognitive deficits in EPT/ELBW children at school entry and justify efforts at early identification and intervention. (JINS, 2011,17, 1067–1079)

Objective To examine neighborhood effects on academic achievement of children with extremely low birth weight (ELBW

To describe the prevalence of behavioral problems and symptomatology suggestive of Autism and Asperger's disorders at age 8 years among extremely low birth weight (ELBW,1 kg) children, born 1992 through 1995.Parent reports of the behavior of 219 ELBW (mean birth weight, 810 g; gestational age 26 weeks) were compared with 176 normal birth weight children of similar maternal sociodemographic status, sex, and age. Behavior was assessed via the Child Symptom Inventory that includes both Symptom Severity Scores and scores meeting DSM-IV criteria for disorders.ELBW compared with normal birth weight children had significantly higher mean Symptom Severity Scores for the inattentive, hyperactive, and combined types of attention-deficit hyperactivity disorder (all p.001) as well as higher scores for Generalized Anxiety (p.01) and Autistic (p.001) and Asperger's (p.01) disorders. When DSM-IV criteria were considered, ELBW children also had significantly higher rates of attention-deficit hyperactivity disorder of the inattentive (10% vs 3%, p.01) and combined (5% vs 0.6%, p.05) types.Attention-deficit hyperactivity disorder, mainly the inattentive type is prevalent among ELBW children. Our findings of an increase in symptoms pertaining to Autistic and Asperger's disorders at school age agree with recent reports of others during early childhood. Early identification and intervention for these problems might improve child functioning and ameliorate parent and child distress.

To examine parent protection and its correlates among 8-year-old ELBW children compared with normal birth weight (NBW) controls.The population included 217 eight-year-old ELBW children born 1992-1995 (92% of the surviving birth cohort; mean birth weight, 811 g; mean gestational age, 26.4 weeks) and 176 NBW controls. The primary outcome measure, the Parent Protection Scale (PPS), included a total score and four domains including Supervision, Separation, Dependence, and Control. Multivariate analyses were performed to examine the predictors of parental protection and overprotection.After adjusting for socioeconomic status (SES), race, sex, and age of the child, parents of ELBW children reported significantly higher mean total Parent Protection Scale scores (31.1 vs 29.7, p = .03) than parents of NBW children and higher scores on the subscale of Parent Control (8.0 vs 7.5, p = .04). These differences were not significant when the 36 children with neurosensory impairments were excluded. Parents of ELBW children also reported higher rates of overprotection than controls (10% vs 2%, p = .001), findings that remained significant even after excluding children with neurosensory impairments (8% vs 2%, p = .011). Multivariate analyses revealed lower SES to be associated with higher total Parent Protection Scale scores in both the ELBW (p.001) and NBW (p.05) groups. Additional correlates included neurosensory impairment (p.05) and functional limitations (p.001) in the ELBW group and black race (p.05) and maternal depression (p.01) in the NBW group. Lower child IQ was significantly associated with higher PPS scores only in the neurosensory impaired subgroup of ELBW children.Longer term follow-up will be necessary to examine the effects of the increased parent protection on the development of autonomy and interpersonal relationships as the children enter adolescence.

The Acropolis (Akropolis) of Athens has played an important role in the history of the city from prehistory to the present day. It is both a physical location, standing on a rocky outcrop above the city, and a locus for the expression of religious and civic identity. Excavations have uncovered evidence of a Mycenaean palace and citadel from the Bronze Age. Habitation and burials continued into the early Iron Age, while evidence for religious activities appears in the 8th century bce. The character of the Acropolis continues to change in the 6th century before becoming the preeminent sanctuary of the city. Herodotus (I, 59) suggests that it was occupied by the ruling family of Athens (Peisistratids), and the remains of a late-6th-century cistern in the northwest corner may indicate the presence of a garrison as well. Several temples were built to honor Athena, patron goddess of the city, and a range of votive offerings, including stone sculpture, bronzes, pottery, and other objects, were dedicated in the sanctuary. In 480/479 bce, the invading Persian army captured and laid waste to Athens, including the sanctuary on the Acropolis. Only decades later, following the defeat of the Persians, did the Athenians begin a systematic rebuilding of the Acropolis. These efforts, initiated by the Athenian statesman and general Pericles, led to the construction of the temple of Athena Parthenos (Parthenon), the Propylaia, the temple of Athena Polias (Erechtheion), and the temple of Athena Nike. For almost a thousand years, the Acropolis functioned as a center of civic and ritual activity dedicated to Athena and other deities. Sometime in the 6th century ce, the Parthenon was converted into a Christian church. Throughout the Middle Ages, the Classical buildings were adapted to new purposes, including residences and churches. Under the Ottoman Empire, the Acropolis was transformed into a village and garrison. In the 19th century, the Acropolis became a symbol and centerpiece of the newly independent Greek nation as excavations removed postclassical remains and restored the ancient monuments. Today, archaeological research and conservation efforts continue to make new discoveries and contribute to our understanding of the Acropolis.

Adult congenital heart disease (ACHD) patients have high rates of untreated depression and anxiety disorders. We evaluated associations among self-reported depression symptoms and alcohol/smoking tobacco use.From 2009 to 2013, 202 ACHD patients (45% male) completed questionnaires on depressive symptoms, anxiety symptoms, and substance use as part of routine clinical care. Data were collected by retrospective chart review.Mean age was 31 ± 10 years, 21% reported often feeling depressed and 33% reported feeling nervous or anxious. Sixty-one percent of patients reported some alcohol intake; 25% reported current or previous smoking tobacco use. Patients with depressive symptoms were 3× as likely to report drinking alcohol (OR 2.89; 95% CI 1.29-6.5) and 5× more likely to report smoking tobacco use (OR 5.17; 95% CI 1.49-17.87). Fourteen percent of patients were prescribed antidepressant/antianxiety medications; 43% of patients on medication reported depressive symptoms. In patients reporting symptoms, those who consumed alcohol were less likely to be on antidepressant/antianxiety medications (21%) than those who did not consume alcohol (56%).Self-reported depressive symptoms are associated with increased alcohol and smoking tobacco use by ACHD patients. Alcohol use may be a means of self-medicating for untreated depression, but further investigation is needed. Risk factors, including depressive symptoms and substance use, should be routinely assessed and addressed in ACHD patients.

Making choices is an essential part of functioning independently as an adult in society. Activities specifically directed toward helping students learn to make choices, however, are typically neglected in educational programs for students with severe disabilities. This paper presents a rationale for the inclusion of choice-making as an important skill area for persons with severe disabilities. Behavioral approaches that present useful means of conceptualizing choice-making in the school life of severely disabled students are identified. Procedures are suggested for teaching choice-making skills, for integrating opportunities for exercising those skills throughout the course of the student's school life, and for fostering choice-making skills through the use of logical consequences.

Data are equivocal regarding the long-term consequences of prenatal exposure to cocaine on school-aged children. We compared 101 children exposed prenatally to cocaine with 130 unexposed children on measures of intelligence, visual motor, and motor abilities at age 7 years. Bivariate analyses revealed that cocaine-exposed children scored significantly lower than comparison children on the abbreviated Wechsler Intelligence Scale for Children-Third Edition Verbal and Full Scale IQ scores, the Visual Motor Integration and Motor Coordination standardized scores, and the Bruininks-Oseretsky Fine Motor Composite score. Regression analyses indicated that the biological mother's vocabulary and home environment assessed at the same 7-year visit were stronger predictors of developmental outcome than prenatal drug exposure. Level of cocaine exposure, however, predicted visual motor and motor skills. The results indicate that although prenatal cocaine exposure may confer some degree of developmental disadvantage in the visual motor domain, it frequently occurs in the context of an inadequate rearing environment, which may be a stronger determinant than prenatal cocaine exposure of children's outcome. J Dev Behav Pediatr 25:83-90, 2004. Index terms: cocaine, development, children, caregiving environment.

To investigate the effects of very low birth weight (VLBW, JINS, 2004,10, 149–163.)

Few investigations have examined the specificity of sequelae of very low birth weight (VLBW,1500 g) or sources of variability in outcome. To better understand the nature and determinants of outcome, we assessed neuropsychological and achievement skills at mean age 11 years in 62 children with750 g birth weight, 54 with 750-1499 g birth weight, and 66 term-born controls. Distinct cognitive constructs were identified by factor analysis, and the three birthweight groups were compared on these constructs and on composite measures of achievement. Although the group with750 g birth weight performed less well on all tests than term-born controls, group differences in a perceptual planning factor and in mathematics remained even when IQ was controlled, and deficits were more pronounced in mathematics than in reading. Results from structural equation modeling were consistent with the hypothesis that neuropsychological skills mediated the relationship between birth weight and achievement. The findings confirm the differential deficit hypothesis, support the need to consider multiple sources of variability in VLBW outcomes, and highlight the importance of neuropsychological constructs in developing an explanatory framework.

Cognitive, behavioral, and learning problems are evident in extremely preterm/extremely low birth weight (EPT/ELBW,28 weeks gestational age or1000 g) children by early school age. However, we know little about how they function within the classroom once they start school.To determine how EPT/ELBW children function in kindergarten classrooms compared to termborn normal birth weight (NBW) classmates and identify factors related to difficulties in classroom functioning.A 2001-2003 birth cohort of 111 EPT/ELBW children and 110 NBW classmate controls were observed in regular kindergarten classrooms during a 1-hour instructional period using a time-sample method. The groups were compared on frequencies of individual teacher attention, competing or offtask behaviors, task management/preparation, and academic responding. Regression analysis was also conducted within the EPT/ELBW group to examine associations of these measures with neonatal and developmental risk factors, kindergarten neuropsychological and behavioral assessments, and classroom characteristics.The EPT/ELBW group received more individual teacher attention and was more often off-task than the NBW controls. Poorer classroom functioning in the EPT/ELBW group was associated with higher neonatal and developmental risk, poorer executive function skills, more negative teaching ratings of behavior and learning progress, and classroom characteristics.EPT/ELBW children require more teacher support and are less able to engage in instructional activities than their NBW classmates. Associations of classroom functioning with developmental history and cognitive and behavioral traits suggest that these factors may be useful in identifying the children most in need of special educational interventions.

Most previous studies of children with birthweight

Recent advances in perinatal care have led to the survival of increasing numbers of children born at the lower limits of viability. Children with very low birth weight (LBW; less than 1,500 g, 3 lb 5 oz) have been studied extensively. Findings document poorer outcomes relative to normal birth weight term-born controls in neurologic and health status, cognitive-neuropsychological skills, school performance, academic achievement, and behavior. This report reviews current knowledge regarding LBW children, with special emphasis on outcomes for children with birth weight less than 750 g (1 lb 10 oz). Results from an ongoing longitudinal study suggest a gradient of sequelae, with poorer outcomes in less than 750 g birth weight children compared to both 750 g to 1,499 g birth weight children and term-born controls. Children with less than 750 g birth weight fail to catch up with their peers over time and may even be at risk for age-related increases in sequelae. Outcomes are highly variable but related to neonatal medical complications of prematurity and social risk factors. Further research is needed to understand the etiology and neuropathological basis of sequelae, the long-term developmental implications of LBW, and treatment needs.

Numerous studies have documented memory deficits in very low birthweight (VLBW, < 1500 g) children, yet we know little about the nature of these memory problems. To clarify memory sequelae and examine memory deficits in relation to the degree of low birth weight, we administered the California Verbal Learning Test-Children's Version (CVLT-C) to a regional sample of 57 < 750 g birthweight children and to groups of 53 750-1499 g birthweight children and 49 term-born controls. Group comparisons revealed significant differences between the < 750 g birthweight group and term-born children on measures of list learning, delayed recall, and inaccurate recall. In addition, the percentage improvement in correct recognitions relative to long-term delayed recall was greater in the < 750 g group than in the term-born controls. Similar differences were observed between VLBW children with and without abnormal neonatal cerebral ultrasounds (high- and low-risk groups). Differences in learning rate between the VLBW and term-born groups, and between high- and low-risk VLBW children, were evident even when vocabulary skill was covaried or when children with neurosensory deficits or IQ < 80 were excluded from analysis. The findings document deficits in verbal memory in the subset of VLBW children at greatest biological risk, and suggest that acquisition processes are selectively impaired.

Although attention deficit disorders are frequently diagnosed in low birth-weight children, it is not clear if attention problems are apparent in neuropsychological testing. The present study examined the performances of a regional sample of 68 children with birth weights

This article is a critique of the claim that the National Weight Control Registry provides data showing that a significant number of adults in the United States have achieved permanent weight loss. We believe that promoting calorie-restricted dieting for the purpose of weight loss is misleading and futile. We advocate the adoption of a health-at-every-size (HAES) approach to weight management, focusing on the achievement and maintenance of lifestyle changes that improve metabolic indicators of health.

With advancements in medical care, many women with complex congenital heart disease (CHD) are now living into adulthood and childbearing years. The strains of pregnancy and parturition can be dangerous in such patients, and careful interdisciplinary plans must be made to optimize maternal and fetal health through this process. Several large studies have been published regarding risk prediction and medical management of pregnancy in complex CHD, though few case studies detailing clinical care plans have been published. The objective of this report is to describe the process of developing a detailed pregnancy and delivery care plan for three women with complex CHD, including perspectives from the multidisciplinary specialists involved in the process. This article demonstrates that collaboration between specialists in the fields of cardiology, anesthesiology, high-risk obstetrics, maternal fetal medicine, and neonatology results in clinically successful individualized treatment plans for the management of pregnancy in complex CHD. Multidisciplinary collaboration is a crucial element in the management of pregnancy in complex CHD. We provide a template used in three cases which can serve as a model for the design of future care plans.

The school-age outcomes of children born at the lowest birthweights and gestational ages since the initiation of aggressive neonatal intensive care have only recently begun to appear in the literature. This paper summarizes the information available from reports of birthweight- and gestational age-based school-age studies. The results reveal relatively high rates of growth, neurosensory and cognitive impairment, together with more subtle neuropsychological and behavioural problems. Evaluation of outcomes has, however, been hampered by the small numbers of children who have reached school age, as well as by the heterogeneity of the population which includes differences in socio-demographic backgrounds, multiple births, small-for-gestational-age children, preferential survival of females and varying rates of neonatal risk factors such as severe periventricular haemorrhage and chronic lung disease. Future studies are needed to confirm present outcomes, to further elucidate the aetiology and pathogenesis of the problems revealed, as well as to evaluate the effects of early intervention in this population.

Since the mid-1980s, increasing numbers of children with birth weights under 750 g have survived to school age.We matched a regional cohort of 68 surviving children born from 1982 through 1986 with birth weights under 750 g (mean, 670 g; gestational age, 25.7 weeks) with 65 children weighting 750 to 1499 g at birth and 61 children born at term. Growth, neurosensory status, and functioning at school age in the three groups were compared. Associations of biologic and social risk factors with major developmental outcomes were examined by means of logistic-regression analyses.Children with birth weights under 750 g were inferior to both comparison groups in cognitive ability, psychomotor skills, and academic achievement. They had poorer social skills and adaptive behavior and more behavioral and attention problems. The mean (+/- SD) Mental Processing Composite score for the cohort was 87 +/- 15, as compared with 93 +/- 14 for children with birth weights of 750 to 1499 g and 100 +/- 13 for children born at term (P0.001). The rates of mental retardation (IQ70) in the three groups were 21, 8, and 2 percent, respectively; the rates of cerebral palsy were 9, 6, and 0 percent; and the rates of severe visual disability were 25, 5, and 2 percent. Major cerebral ultrasonographic abnormalities were associated with mental retardation (odds ratio, 5.4; 95 percent confidence interval, 1.8 to 15.8) and cerebral palsy (odds ratio, 15.2; 95 percent confidence interval, 3.0 to 77.4). Oxygen dependence at 36 weeks was associated with mental retardation (odds ratio, 4.5; 95 percent confidence interval, 1.2 to 10.7) and severe visual disability (odds ratio, 4.3; 95 percent confidence interval, 1.3 to 14.2). Social disadvantage, though associated with several neuropsychological outcomes, was not associated with major developmental impairment.Children with birth weights under 750 g who survive represent a subgroup of very-low-birth-weight children who are at high risk for neurobehavioral dysfunction and poor school performance.

Although very-low-birth-weight (VLBW) infants, those weighing less than 1500 g, gained significantly better outcomes when neonatal intensive care became available in the 1960s, studies of later mental development have given mixed results. This longitudinal study enrolled 242 VLBW infants born in the years 1977-1979 who survived and 233 control infants of normal birth weight from the same population. The mean gestational age of the VLBW group at birth was 29.7 weeks. Intelligence testing was performed at age 20 with the Vocabulary and Block Design subtests of the Short Form of the Wechsler Adult Intelligence Scale-Revised. These tests measure verbal comprehension and perceptual-organizational skills, respectively. Academic skills were evaluated using the Letter-Word Identification and Applied Problems subtests of the Woodcock-Johnson Psycho-Educational Battery-Revised. The VLBW and normal-weight groups were sociodemographically similar, but the former group had significantly more chronic conditions than did control group. The major differences were in neurosensory impairment and subnormal height. Fewer subjects in the VLBW group had graduated from high school or obtained a general equivalency diploma by age 20. Although 40% of the VLBW group had repeated a grade, the figure for control subjects was 27%. Fewer VLBW subjects were enrolled in post-secondary studies. These differences remained significant when analysis was limited to those of normal IQ who had no neurosensory impairment. Mean IQ scores were significantly lower in the VLBW group (87 vs. 92, P

Background Thin children are less muscular, weaker, less active, and have lower performance in measures of physical fitness than their normal weight peers. Thin children are also more frequently subjected to teasing and stigmatization. Little is known about thin children's weight perceptions, desired weight and attitudes and behaviours towards food and exercise. The study aimed to compare perceived weight status, desired weight, eating and exercise behaviours and advice received from parents among thin, overweight, obese or normal weight Australian children and adolescents. Methods The sample included 8550 school children aged 6 to 18 years selected from every state and territory of Australia. The children were weighed, measured and classified as thin, normal, overweight or obese using international standards. The main outcome measures were perceived and desired weight, weight related eating and exercising behaviours, and advice received from parents. Results The distribution of weight status was - thin 4.4%; normal weight 70.7%; overweight 18.3%; and obese 6.6%. Thin children were significantly shorter than normal weight, overweight or obese children and they were also more likely to report regularly consuming meals and snacks. 57.4% of thin children, 83.1% of normal weight children, 63.7% of overweight and 38.3% of obese children perceived their weight as "about right". Of the thin children, 53.9% wanted to be heavier, 36.2% wanted to stay the same weight, and 9.8% wanted to weigh less. Thin children were significantly less likely than obese children to respond positively to statements such as "I am trying to get fitter" or "I need to get more exercise." Parents were significantly less likely to recommend exercise for thin children compared with other weight groups. Conclusions Thin children, as well as those who are overweight or obese, are less likely than normal weight children to consider their weight "about right'. Thin children differ from children of other weights in that thin children are less likely to desire to get fitter or be encouraged to exercise. Both extremes of the spectrum of weight, from underweight to obese, may have serious health consequences for the individuals, as well as for public health policy. Health and wellness programs that promote positive social experiences and encourage exercise should include children of all sizes.

To evaluate the effect of embryo transfer number on singleton and twin pregnancy outcomes with one and two fetal heartbeats on early ultrasound, respectively.The study included 23,645 singleton and 14,083 twin live births from the SART-CORS Online database of assisted reproductive technology cycles for 2004-2006. The data were limited to fresh embryo transfers among women who had additional embryos cryopreserved during the same cycle, resulting either in one fetal heartbeat on early ultrasound and a singleton live birth, or two fetal heartbeats and a twin live birth. Data were categorized by number of embryos transferred; the reference group was one for singletons and two for twins. The primary outcome measure was moderate growth restriction (birthweight for gestation z-score-1), adjusted for potential confounders.Risk for moderate growth restriction among singletons was increased by 15%, 23%, and 37%, respectively, with 2, 3, andor = 4 embryos transferred, and among twins, by 50% and 105%, respectively, with 3 andor = 4 embryos transferred.The data demonstrate a significant residual adverse effect on intrauterine growth from transfer of multiple embryos. Whether this effect is due to compromised embryo quality, degenerating implantation sites, or other etiology is unclear.

To evaluate the effect of first trimester fetal losses in singleton births from assisted reproductive technology using data from the Society for Assisted Reproductive Technology national database for 2005.Historic cohort study.Clinic-based data.The study population included 21,535 singleton deliveries ofor=22 weeks gestation categorized by the number of fetal heartbeats identified on early ultrasound as one, two, three, or more.None.Length of gestation, birthweight, and birthweight for gestation. Odds ratios (ORs) were calculated, with the group with one fetal heartbeat on early ultrasound as the reference.Preterm birth (37 weeks, OR 1.73; 32-36 weeks, OR 1.59;32 weeks OR 2.56) and low birthweight (2,500 g, OR 2.09; 1,500-2,499 g, OR 1.94) increased and term birth and nonlow birthweight decreased (OR 0.52 and 0.48) with more than one fetal heartbeat.Early fetal loss in pregnancies that result in a singleton live birth is associated with significantly increased odds for lowered birthweight, shortened gestation, and reduced birthweight for age. Because first trimester multiple fetal heartbeats are more common in assisted-conception pregnancies than in unassisted pregnancies, this factor may help explain the greater risk for reduced birthweight and shorter gestations observed in this population.

A cohort of 219 children with extremely low birth weight (

OBJECTIVE. The purpose of this study was to document the impact and burden of extremely low birth weight (METHODS. A prospective study was completed at 8 years of a cohort of 219 children with extremely low birth weight born 1992–1995 and 176 children with normal birth weight. Measures included the following predictor variables: socioeconomic status and parent risk, birth risk, neonatal risk, neurodevelopmental outcome, impairment in adaptive abilities, and functional impact of chronic conditions. The primary outcome measure was the Impact on Family scale. A measure of family stressors and resources (the Life Stressors and Social Resources Inventory) was also obtained.RESULTS. The primary finding was that the total family impact was greater in the extremely low birth weight group compared with controls. Moreover, the negative impact on family in specific domains was greater in the extremely low birth weight group in financial impact, caretaker burden, and familial burden. These differences were not attributable to general family stressors, socioeconomic status, child, gender, or race. Higher parent/socioeconomic risk, neurodevelopmental outcomes, and the functional impact of chronic conditions predicted greater family impact within the extremely low birth weight group, whereas birth and neonatal risk scores did not.CONCLUSIONS. Extremely low birth weight was associated with a negative impact on families. Socioeconomic parental risk, but most especially child-related factors such as neurodevelopmental and the functional impact of chronic conditions, predicted the negative family impact within the extremely low birth weight group. Findings underscore the need to develop and test interventions to provide support for families of extremely low birth weight infants to ameliorate the burden of extremely low birth weight and associated risk factors on families.

Objectives Although children with very low birth weight (VLBW

Objective. The Bayley Scales of Infant Development, Second Edition (BSID II) are commonly used to assess outcomes of extremely low birth weight (ELBW) infants. We sought to assess the predictive validity of the BSID II Mental Developmental Index (MDI) for cognitive function at school age.Design/Methods. Of 330 ELBW infants admitted in 1992–1995, 238 (72%) survived to the age of 8 years, of whom 200 (84%) were tested at both 20 months’ corrected age (CA) and 8 years. Mean birth weight was 811 g, mean gestational age was 26.4 weeks, 41% were boys, and 60% were black. Measures included the BSID II at 20 months’ CA and the Kaufman Assessment Battery for Children (KABC) Mental Processing Composite (MPC) at 8 years’ postnatal age. BSID II MDI and MPC scores were compared and the predictive validity calculated for all 200 ELBW children and for the 154 ELBW neurosensory-intact subgroup. Predictors of stability or change in cognitive scores were examined via logistic regression adjusting for gender and sociodemographic status.Results. For all ELBW children, the mean MDI was 75.6 ± 16 versus a mean KABC of 87.8 ± 19. For the neurosensory-intact subgroup, the mean MDI was 79.3 ± 16 and the mean KABC was 92.3 ± 15. Rates of cognitive impairment, defined as an MDI or KABC of 70.Conclusions. The predictive validity of a subnormal MDI for cognitive function at school age is poor but better for ELBW children who have neurosensory impairments. We are concerned that decisions to provide intensive care for ELBW infants in the delivery room might be biased by reported high rates of cognitive impairments based on the use and presumptive validity of the BSID II MDI.

ContextInformation on the school-age functioning and special health care needs of extremely low-birth-weight (ELBW

As part of a longitudinal study of the outcomes of very low birth weight children (

Subnormal head circumference (HC) has been associated with poor neurologic and developmental outcomes.To examine the correlates and consequences of subnormal HC in a cohort of school age, very low birth weight (VLBW,1,500 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 of750 g birth weight children and matched children with 750-1,499 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.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.001), SGA status (52% vs. 27%, p.05), high neonatal risk (57% vs. 29%, p.05), and neurosensory impairment (23% vs. 8%, p.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.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.

Objective. Information on the mental health of very low birth weight (VLBW; Methods. We compared a cohort of 241 survivors among VLBW infants who were born between 1977 and 1979 (mean birth weight: 1180 g; mean gestational age at birth: 29.7 weeks), 116 of whom were men and 125 of whom were women, with 233 control subjects from the same population in Cleveland who had normal birth weights (108 men and 124 women). Young adult behavior was assessed at 20 years of age with the Achenbach Young Adult Self-Report and the Young Adult Behavior Checklist for parents. In addition, the young adults and parents completed the ADHD Rating Scale for Adults. Gender-specific outcomes were adjusted for sociodemographic status.Results. VLBW men reported having significantly fewer delinquent behaviors than normal birth weight (NBW) control subjects, but there were no differences on the Internalizing, Externalizing, or Total Problem Behavior scales. Parents of VLBW men reported significantly more thought problems for their sons than did parents of control subjects. VLBW women reported significantly more withdrawn behaviors and fewer delinquent behavior problems than control subjects. Their rates of internalizing behaviors (which includes anxious/depressed and withdrawn behaviors) above the borderline clinical cutoff were 30% versus 16% (odds ratio: 2.2; 95% confidence interval [CI]: 1.2-4.1). Parents of VLBW women reported significantly higher scores for their daughters on the anxious/depressed, withdrawn, and attention problem subscales compared with control parents. The odds ratios for parent-reported rates above the borderline-clinical cutoff among women for the anxious/depressed subscale was 4.4 (95% CI: 1.4-13.5), for thought problems was 3.7 (95% CI: 1.2-11.6), and for attention problems was 2.4 (95% CI: 1.0-5.5). There were no differences in the young adult self-report of attention-deficit/hyperactivity disorder (ADHD). Parents of VLBW men reported higher mean scores on the attention subtype of ADHD but not higher rates of ADHD.Conclusion. The increase in psychopathology among VLBW survivors in young adulthood indicates a need for anticipatory guidance and early intervention that might help to prevent or ameliorate potential psychopathology.

A prospective follow-up of very low birth weight infants (VLBW) with (n=89) and without (n=71) bronchopulmonary dysplasia (BPD) and Term control children (n=93) was conducted at 8 years of age. Groups were compared on measures of articulation, receptive and expressive language, verbal and performance IQ, oral motor skills and gross and fine motor skills. The BPD group demonstrated reduced articulation, receptive language skills, performance IQ, and overall gross and fine motor skills when compared to VLBW and Term groups. The BPD and VLBW groups did not differ on expressive language, oral motor skills, or verbal IQ. The groups also differed in enrolment in special classes and speech–language therapy, with almost half (48%) of the BPD group enrolled in speech–language therapy compared to 21% of the VLBW group, and 9% of the Term group. These results suggest that BPD may have adverse effects on speech development as well as on performance IQ, motor skills, and receptive language over and above the effects of VLBW. Learning outcomes (1) As a result of this activity the reader will be able to describe what BPD is and how it impacts speech and language. (2) As a result of this activity the reader will be able to discuss how children with VLBW with BPD differ from children with VLBW without BPD in their developmental outcomes.

Objective To examine long-term outcomes in families of children with very low birth weights ( Design Concurrent/cohort prospective study. Setting Regional follow-up program. Participants Families of 60 children of school age with birth weights less than 750 g, 55 with birth weights between 750 and 1499 g, and 49 normal birth weight full-term controls. Main Outcome Measures Parent ratings of psychological distress, family function, and child-related stress. Results Families with children with birth weights less than 750 g experienced greater stress than did families of controls (born at full term), and families who were sociodemographically advantaged experienced greater stress than did those who were disadvantaged. Higher neonatal medical risk also predicted a more negative impact on the family, but only in advantaged families. Regression analyses suggested that adverse family outcomes were mediated by ongoing problems in child functioning. Conclusions Families of children with birth weights less than 750 g experience more long-term adversity than families of full-term children. Family sequelae are also present for children with very low birth weight at high neonatal medical risk. Ongoing child health and behavior problems may be the major source of these sequelae, and sociodemographic status is an important consideration in identifying family adversity. Although many families appear unaffected, results support the need to monitor family outcomes and develop interventions for both the child and family.