Aim To study the prediction of cognitive development with a group of very low birthweight infants (<1500 g) at 18 months and at 4 years of age.Methods Bayley Scales of Infant Development-II Mental Development Indexes (MDI), and Stanford-Binet Intelligence Scale (S-B) Composite Scores were studied in a population of 334 children with birthweights <1500 g. Independent variables measured were gestational age, birthweight, gender and parental socio-economic status (SES).Results Longer gestation (28 weeks and over) and higher birthweight (1000-1500 g) proved to be advantageous for cognitive ability at both 18 months and 4 years. Other significant advantages were associated with female and higher SES. High correlations were found between MDI and the S-B Composite Score (r = 0.62), and between birthweight and gestation (r = 0.72). When information available at birth was included in forward stepwise regression analyses to predict the S-B Composite at 4 years, the best predictors were MDI at 18 months and SES.Conclusion With the measures employed and this population, prediction of cognitive development from early childhood to preschool was possible. This may enable reliable identification of those children at risk for delayed cognitive development who require intervention before starting school.

AIM:To report the findings of an audit of 91 < 1,500 grams birthweight children at four years of age and consider the cognitive and behavioural results in the light of gestation, birthweight and socio-economic status. METHOD:Children born in 1993 were assessed using the Stanford-Binet Intelligence Scale, Conners' Parent Rating Scales and clinical evaluation. Parent interview provided further information on development, health and behaviour. RESULTS:Significant differences were demonstrated in a number of comparisons. For the Stanford-Binet results, children >28 weeks gestation obtained higher mean scores than those of shorter gestation for Abstract Visual Reasoning (representing cognitive skills such as spatial perception and visual - motor coordination), and Quantitative Reasoning (which includes numerical ability). In the case of birthweight, the mean score for children > or = 1,000 grams was higher on Quantitative Reasoning than that obtained by the lower birthweight group. When socioeconomic status classification was introduced, a number of differences in test scores were apparent, with children whose parents were in the lowest classification consistently performing less well. Quality of language results followed the same pattern. Analysis of the Conners' Scales identified this low socio-economic status group as having more learning problems and higher scores on the Hyperactivity Index than those whose parents were in the highest socioeconomic status group. CONCLUSION:Results for cognitive performance on the Stanford-Binet Scale were within one standard deviation of the mean, for the study population as a group. However, findings suggested that children <1,000 grams birthweight, or <28 weeks gestation, and those <1,500 grams with parents in the lowest socio-economic group, were at particular risk of achieving lower scores prior to school entry. Their pattern of cognitive ability and behaviour could inhibit their adjustment to formal education when complex concepts require problem solving at a more advanced level.

Aims. Aims of this paper were to carry out an audit of 105 extremely low birth weight infants at 18 months of age, identifying problems, disseminating the resulting information and providing a basis for future work.Methods. Children born in 1990-2 were classified in categories I to IV according to outcome, and selected perinatal variables were analysed for these groupings.Results. The disability rate (categories I and II) within this cohort was 21%, a similar finding to that reported in other literature. For the group with slow motor development and or tonal abnormalities the percentage was 15. Despite the high risk nature of this group 64% of children were progressing well (category IV) at this age.No significant differences in outcome were found between small for gestational age and appropriate weight for gestational age infants. Significant results were demonstrated in the adverse effects of chronic lung disease and intraventricular haemorrhage on subsequent development.Conclusion. The information obtained from this study provides support for the use of this type of audit in Units with extremely low birth weight populations.

Development, medical history and social background of 79 sudden infant death syndrome (SIDS) and 79 age matched controls were compared. SIDS was associated with a high proportion of S.G.A. infants, more hospital admissions and increased reporting of symptoms, particularly irritability, by parents. Social factors did not play a significant role with no evidence of marked social deprivation or lack of caring in either group. When this background data from both groups was compared there was no evidence of reliable predictors of sudden infant death.

A boy with agammaglobulinaemia diagnosed and treated from the age of 3 years 2 months developed encephalitis at 4 years 3 months. The illness showed a remitting but deteriorating course until death aged 6 years 5 months. Echo virus type 27 was isolated from the cerebrospinal fluid during the terminal illness. The virus was not isolated from five earlier cerebrospinal fluid samples nor was virus detected in a temporal lobe biopsy.

The cognitive development of children whose mothers had been included in the first Auckland trials of betamethasone therapy in premature labor were studied. An earlier study of these children used psychometric tests during the fifth year of life. In the present study tests were given during the seventh year of life (the second year of school) to 250 (82.2%) of 304 surviving children. Of the 250 children, 139 were in the group whose mothers had received betamethasone and 111 were in the control group. Further tests of cognitive development were made, together with assessment of the children's progress in school. Again, on the majority of measures there were no significant differences between children whose mothers had received betamethasone and the children in the control group. Calculations of statistical power showed that important differences were unlikely to have been missed.

The present study was part of a larger study investigating the long-term development of children of mothers included in a controlled trial of betamethasone therapy in preterm labor; the purpose was to determine whether there are any benefits or hazards of treatment detectable up to the seventh year of life. The first 318 children of mothers included in the trial because of spontaneous premature labor were selected for study. Of 305 survivors, 258 (84.6%) were included in this phase of the study. Detailed tests of psychological development, together with assessments of psychosocial background, were made during the fifth year. Of the 258 children 144 were in the betamethasone group and 114 were control patients. Despite a heavy weighting of the betamethasone group with more prematurely delivered infants and more boys (resulting from improved perinatal survival of these children associated with betamethasone therapy), no significant differences emerged between the groups in measures of outcome. It was concluded that betamethasone therapy, under the conditions of the original trial, was not hazardous to cognitive development as measured in this study.

A followup study of 17 infants with gastroenteritis and hyperosmolar dehydration, four of whom showed neurological abnormality during the acute phase of their illness, revealed one case to have mild psychomotor retardation at the age of four years. This infant, the only one who convulsed during the illness, had been rehydrated rapidly because serum sodium concentration was only 149 mmol/l despite a blood urea of 27.5 mmol/l. Stanford-Binet psychometric assessment at age four years showed a positive relationship with socio-economic status of the family, and a negative relationship with blood urea concentration at the time of initial illness.

Summary o.1.Thirteen of 15 children who developed meningoencephalitis due to Coxsackie virus group B5 in the neonatal period had physical development, scores for intelligence and visual perception at the age of 6 years similar to those of 15 control children matched for sex, birth weight, gestational age, and socioeconomic status. 2.Two of three infants who were noted to be irritable or twitching in association with the meningoencephalitis in the neonatal period developed spasticity and their intelligence was below the mean for the group. 3.The three infants who also had myocarditis had no sequelae at the age of 6 years. Summary o.1.Thirteen of 15 children who developed meningoencephalitis due to Coxsackie virus group B5 in the neonatal period had physical development, scores for intelligence and visual perception at the age of 6 years similar to those of 15 control children matched for sex, birth weight, gestational age, and socioeconomic status. 2.Two of three infants who were noted to be irritable or twitching in association with the meningoencephalitis in the neonatal period developed spasticity and their intelligence was below the mean for the group. 3.The three infants who also had myocarditis had no sequelae at the age of 6 years.