Predictors of neurodevelopmental outcome of Malaysian very low birthweight children at 4 years of age

• Published in: Journal of paediatrics and child health 2001-08, Vol.37 (4), p.363-368
• Main Authors: Ong, LC, Boo, NY, Chandran, V
• Format: Article
• Language: English
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Child Development; Child, Preschool; Cohort Studies; Emergency and intensive care: neonates and children. Prematurity. Sudden death; Female; Humans; Infant, Newborn; Infant, Very Low Birth Weight - growth & development; Intelligence; Intensive care medicine; Logistic Models; Malaysia; Male; Medical sciences; neonatal cerebral ultrasound; Neurodevelopmental aspects; Predictive Value of Tests; Predictors; Preschool children; social risk; Surveys and Questionnaires; Very low birth weight; very low birthweight
• ISSN: 1034-4810; 1440-1754
• DOI: 10.1046/j.1440-1754.2001.00694.x

Objective: To determine neonatal, early developmental and social risk factors that predict the neurocognitive and behavioural outcome of very low birthweight (VLBW) preschool children at four years of age. Methodology: From a cohort of 151 eligible VLBW survivors born in Kuala Lumpur Maternity Hospital, 116 (76.8%) were prospectively followed up from birth till four years. A standardised neurological examination was performed at one and four years to determine the presence of impairment and cerebral palsy, respectively. Cognitive development was assessed using the Mental Scale of the Bayley Scales of Infant Development (MDI) at one year and the Weschler Preschool and Primary Scale of Intelligence‐Revised (WIPPSI‐R) at four years. Motor coordination was assessed using the Movement Assessment Battery for Children (Movement‐ABC). Mothers completed the Child Behaviour Checklist (CBCL) and Parenting Stress Index (PSI) questionnaires. Logistic and multiple regression analyses were used to determine factors associated with cerebral palsy, IQ scores, Movement‐ABC and CBCL scores. Results: Factors associated with cerebral palsy were lower MDI scores at one year (P = 0.001) and late neonatal cranial ultrasound abnormalities (P = 0.036). Minor (P = 0.016) or major impairment (P = 0.003) at one year of age and a low level of paternal education (P = 0.01) were associated with poor motor function on the Movement‐ABC scale. Lower levels of maternal education (P < 0.001), impairment at one year (P = 0.002) and late neonatal cranial ultrasound abnormalities (P = 0.039) predicted Full Scale IQ scores. Higher PSI scores (P = 0.001), younger mothers (P = 0.003) and late neonatal cranial ultrasound abnormalities (P = 0.009) were associated with worsened child behaviour scores on the CBCL scale. Conclusion: Social factors and the caregiving environment were important determinants of cognitive and behavioural outcome. Cranial ultrasound abnormalities in the late neonatal period and the developmental status at one year might be useful in identifying high risk infants in need of long‐term surveillance.