Fræðigrein

Læknablaðið 2004; 90: 747-54

Objective: This study was part of a geographically defined national study on survival, health, development, and longterm outcome of extremely low birthweight infants (ELBW; birthweight < 1000g) in Iceland focusing on development and neurodevelopmental measures in comparison to a reference group.

Methods: All 35 ELBW longtime survivors born in 1991-95 and 55 children as matched reference group were enrolled in a prospective study on longterm health and development. The children underwent medical examinations and neurodevelopmental testing at five years of age in 1996-2001, and their parents answered a questionnaire on their behavior. Comparison was made between ELBW infants and the reference group.

Results: Cognitive measures with the Wechsler Pre­­-school and Primary Scale of Intelligence-Revised (WPPSI-R) showed significantly lower full scale IQ scores for the ELBW group compared to the reference group (p<0.001). More difference was apparent between the groups for the performance IQ than the verbal IQ. Scores on Test of Language Development (TOLD-2P) showed differences between the ELBW group and the reference group on the total language quotient (p=0.025). Significant differences were not obtained between the groups on TOLD-2P´s individual subtests, languistic features nor linguistic systems. Total Scores on the Miller Assessment for Preschoolers (MAP) with emphasis on sensory motor development, were significantly lower for the ELBW group compared to the reference group (p<0.001). Additionally, significant differences were found on three of five subscales of the MAP. Evaluation of fine motor skills with the Finmotorisk utvecklingsstatus 1-7år (FU) revealed significant differences (p<0.001), favoring the reference group. Parental answers on the Child Behavior Checklist (CBCL) showed differences between the groups on three of eight factors in favor of the reference group (p<0.001).

Conclusions: Developmental testing at five years of age indicates that the performance of 25% of the ELBW children in this study, is consistent with that of same age peers. However, as a group, the ELBW children performed significantly poorer regarding cognitive development and sensory-motor skills when compared to the reference group. The most prominent neurodevelopmental difficulties of the ELBW children were within perceptual organization, coordination, and executive skills. Behavior problems were not rated as significant according to parental answers, although there were some differences between the groups. Since a large portion of ELBW children experiences developmental problems, it is important to provide early intervention during preschool years and support services and special education during school years, to reduce the longterm effects of developmental deficits.