Cognitive and educational outcome of very-low-birthweight children in early adolescence

To determine whether poor motor skills, previously identified in a cohort of very low birthweight (< 1250 g) children, born in 1980-1, have persisted or improved. Previous assessments had shown significant improvement between the ages of 6 and 8 years. The original cohort were traced and were assessed using the Movement Assessment Battery for Children, an update of the Test Of Motor Impairment, used at 6 and 8 years. Where possible the classroom-matched controls from the original studies were assessed, otherwise new controls were selected. Teachers were also asked to identify those children whom they considered clumsy. Forty seven of the original cohort of 53 children, all but one still attending mainstream school, and 40 original and 20 new classroom-matched controls were studied. Fifty one per cent of the cohort showed clinically important or borderline impairment. More of these children had significant impairment (16/47, 34%) than the controls (3/60, 5%). The improvement seen by 8 years of age was maintained but there was no further improvement. Girls had significantly higher overall impairment scores (median 16; interquartile range 10-21.5) than the boys (5.5 (1.5-12.5)), and on a wider variety of subtests (5/8) than the boys (3/8). Many very low birthweight children have impaired motor skills. Despite early improvement it persists into adolescence and the deficit remains. Interventional studies may help to see if these problems can be alleviated.

To compare the growth of very low birthweight (VLBW) children in early adolescence with that of their normal birthweight peers; to examine the role of factors contributing to growth-parental height, perinatal variables, bone maturity and sexual maturation; to examine the correlation between head growth and cognitive and educational outcome. Standing and sitting heights, weight, occipito-frontal circumference (OFC), skinfold thicknesses and pubertal staging were assessed in 137 VLBW children and 160 controls at 11-13.5 years of age. Ninety six (70%) of the VLBW children had their bone age assessed using the TW2 method. Reported parental heights were obtained by questionnaire. All children had standardised tests of cognitive and educational ability. Perinatal data had been collected prospectively as part of a longitudinal study. VLBW children had lower heights, weight, and OFC. Skinfold thicknesses were no different. The children's short stature was not accounted for by difference in parental height, degree of pubertal development, or by retarded bone age. Indeed, the TW2 RUS score was significantly advanced in the VLBW children. Using the bone ages to predict final adult height, 17% have a predicted height below the third centile and 33% below the tenth. Weight was appropriate for height, but there was a residual deficiency in OFC measurements after taking height into account. In the VLBW group smaller head size was associated with lower IQ and mathematics and reading scores. Growth problems persist in VLBW children and final heights may be even more abnormal than present heights suggest. VLBW children have smaller OFCs than expected from their short stature alone and this may be associated with poorer educational and cognitive outcomes.