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Attention deficits are common in children born very preterm (VP), especially for children with higher social risk. The aim of this study was to examine the association between parenting behavior and attention in children born VP, and whether this association is influenced by familial social risk. Two hundred and twenty-four children born30 weeks' gestation and/or with a birth weight1250 g were recruited at birth. At 2 years, social risk was calculated and parenting behaviors were observed during a parent-child interaction task, with children's attention skills assessed at 7 and 13 years using standardized assessments. Higher levels of sensitive parenting at 2 years were positively associated with divided attention at age 7 years, and higher levels of intrusive parenting were negatively associated with divided attention at 13 years. Children born VP with higher social risk were more positively influenced by sensitive parenting behavior for sustained attention at 7 years, selective attention at 13 years, and divided attention at 7 and 13 years than children born VP with lower social risk. Additionally, children born VP with higher social risk were more negatively influenced by intrusive parenting for sustained attention outcomes at 7 years than those with lower social risk. In summary, the evidence for a contribution of early parenting to attention outcomes in children born VP was stronger for more complex attention (divided attention) compared with basic attention domains. Our findings also suggest that early parenting behavior has a particular influence on children born VP from socially disadvantaged environments for attention outcomes.

OBJECTIVE To examine the individual and collective contribution of biological and socioenvironmental factors associated with language function at 2, 5, 7, and 13 years in children born preterm (

OBJECTIVE: To examine the stability of developmental coordination disorder (DCD) throughout childhood in children born very preterm and term. Further, in the very preterm group, to compare perinatal variables and neurobehavioral outcomes at 13 years of age for children with persisting DCD and those with typical motor development. STUDY DESIGN: Prospective study of 180 very preterm and 73 term-born children assessed at 5, 7, and/or 13 years of age using the Movement Assessment Battery for Children, with scores ≤16th percentile used to classify DCD. Children with cerebral palsy or an IQ of

OBJECTIVES: The objective of this study was to describe language functioning at 13 years of age and examine its developmental trajectory from 2 to 13 years of age in children born very preterm (VP) compared with term controls. METHODS: Two hundred and twenty-four children born VP ( RESULTS: Compared with term controls, children born VP had poorer functioning across all components of language (mean group differences ranged from −0.5 SD to −1 SD; all P < .05) at 13 years of age. At each follow-up age, the VP group displayed poorer language functioning than the term controls, with the groups exhibiting similar developmental trajectories (slope difference = −0.01 SD per year; P = .55). CONCLUSIONS: Children born VP continue to display language difficulties compared with term controls at 13 years of age, with no evidence of developmental “catch-up.” Given the functional implications associated with language deficits, early language-based interventions should be considered for children born VP.

Objective To identify distinct language trajectories of children born very preterm and full term from 2 to 13 years of age and examine predictors for the identified trajectories. Study design A cohort of 224 children born very preterm and 77 full term controls recruited at birth were followed up at ages 2, 5, 7, and 13 years. The number of distinct language trajectories was examined using latent growth mixture modeling allowing for linear and quadratic time trends. Potential predictors in the neonatal period (eg, birth group, sex, and medical risk) and at 2 years (ie, social risk and use of allied health services) for the language trajectories were tested using multinomial logistic regression. Results Five distinct language trajectories were identified across childhood: stable normal (32% of study cohort), resilient development showing catch-up (36%), precocious language skills (7%), stable low (17%), and high-risk (5%) development. The very preterm group was 8 times more likely to have a language trajectory that represented poorer language development compared with full term controls (very preterm, 40%; full term, 6%). Greater social risk and use of allied health services were associated with poorer language development. Conclusions Variable language trajectories were observed, with a substantial proportion of children born very preterm exhibiting adverse language development. These findings highlight the need for monitoring language skills in children born very preterm before school entry and across middle childhood.

This longitudinal study investigated language development from 2 to 13 years and the early determinants for poorer language outcomes in children born very preterm. Language function was poorer in very preterm children compared with their peers, with no evidence of catch-up or decline from 2 to 13 years. Five distinct language trajectories revealed that 40% of very preterm children displayed adverse language development across childhood. Socio-environmental factors had important associations with language development, while biological risk factors had negligible influences. Language remains an important area of consideration for very preterm children and this research informs long-term management and intervention strategies.

Objectives Although a number of studies have shown misoprostol's promise as a nonsurgical treatment for incomplete abortion, few have systematically examined treatment protocols. This study documents the effectiveness of 600 versus 1200 ��g oral misoprostol for this indication. Methods From May 2002 to January 2003, 300 women with incomplete abortion were recruited at a large tertiary facility in Vietnam and randomized to either a single-dose (600 ��g) or a repeated-dose (600 ��g��2) regimen of oral misoprostol for the treatment of their condition. Results Misoprostol effectively evacuated the uterus for nearly all women (94.6%; n =279), with most reporting bleeding for 4 days (��2.3) and pain/cramps lasting 1 day (��1.0). Women indicated that the side effects were tolerable (96%) and that their experience was satisfactory (95%). Conclusions Oral misoprostol (600 or 1200 ��g) offers a safe, effective and acceptable treatment for incomplete abortion. Larger studies to assess the advantages and disadvantages of misoprostol as compared with standard surgical care are needed to assess its role in postabortion care programs worldwide.

In high-resource settings, standard treatment of postpartum hemorrhage relies heavily on hospital-based interventions, and maternal death from hemorrhage is rare. Simpler methods are needed for intervention at all levels of care, especially in low-resource settings in rural areas. Misoprostol, a prostaglandin E1 analog, has been used for the management of postpartum hemorrhage although it is less effective than oxytocin. But because it has a number of advantages including ease of administration, thermostability, and relatively low cost, it can be of benefit in low resource settings. Three placebo-controlled randomized trials compared the use of misoprostol plus uterotonics and uterotonics alone in women with postpartum hemorrhage. Although a meta-analysis of these trials reported that addition of misoprostol was associated with 40% to 50% reduction in blood loss of 500 mL or more, the sample sizes were too small in these studies to make a meaningful conclusion. Moreover, a systematic review concluded that evidence for any benefit of addition of misoprostol to standard uterotonic treatment was insufficient. This multicenter, double-blinded, placebo-controlled, randomized trial investigated whether adjunctive use of misoprostol in women with postpartum hemorrhage could reduce blood loss more than standard uterotonic treatment alone. The participants were 1422 women delivering vaginally who had clinically diagnosed postpartum hemorrhage due to uterine atony. Between 2005 and 2008, all participants were enrolled from hospitals in Argentina, Egypt, South Africa, Thailand, and Vietnam. The women were randomly assigned to receive 600 μg misoprostol (n = 705) or matching placebo (n = 717) sublingually; both groups were also given routine injectable uterotonics. Special care was taken to conceal allocation. Both providers and participants were blinded as to treatment allocation. The primary study outcome measure was blood loss of 500 mL or more within 60 minutes after. There was no significant difference between the 2 groups in the proportion of women with measured blood loss of 500 mL or more (misoprostol group: 100 [14%] vs. the placebo group: 100 [14%]; the relative risk was 1.02, with a 95% confidence interval of 0.79-1.32). Within 60 and 90 minutes after randomization, compared with placebo, misoprostol was associated with an increased proportion of women with shivering, body temperature of 38°C or higher, and vomiting. These findings do not support the use of misoprostol as an adjunct to conventional uterotonics for the treatment of women with postpartum hemorrhage.