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Lower cognitive test scores at age 7 in children born with marginally low birth weight
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.ORCID iD: 0000-0001-7341-8254
Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.ORCID iD: 0000-0003-4191-3781
Division of Neonatology, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.ORCID iD: 0000-0002-3187-067X
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.ORCID iD: 0000-0002-0726-7029
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2018 (English)In: Pediatric Research, ISSN 0031-3998, E-ISSN 1530-0447, Vol. 83, no 6, p. 1129-1135Article in journal (Refereed) Published
Abstract [en]

Background: Being born with very low birth weight (<1500 g) is associated with poorer neurocognition later in life. The aim of this study was to explore neurodevelopmental functions in those born with marginally LBW (2000–2500 g).

Methods: This was originally a randomized controlled trial investigating the effects of early iron supplementation in 285 marginally LBW children. Herein, we explored the combined marginally LBW group and compared their results to 95 normal birth weight (NBW; 2501–4500 g) controls in an observational design. At 7 years, a pediatric psychologist tested the children using Wechsler Intelligence Scale for Children (WISC IV), Beery–Buktenica developmental test of Visual–Motor Integration (Beery VMI), and Test of Everyday Attention for Children (TEA-Ch).

Results: The marginally LBW children had lower verbal comprehension intelligence quotient (IQ) (104 vs. 107, P=0.004), lower VMI scores (96.5 vs. 100, P=0.028), and lower total mean TEA-Ch scores (8.5 vs. 9.7, P=0.006), compared to controls. Also, the marginally LBW children group had a higher proportion of children below −1 SD for VMI and TEA-Ch.

Conclusions: Marginally LBW children had lower verbal comprehension IQ, lower visual–motor integration, and lower attention performance than NBW children, suggesting an increased risk of cognitive difficulties in early school age

Place, publisher, year, edition, pages
Nature Publishing Group, 2018. Vol. 83, no 6, p. 1129-1135
National Category
Pediatrics
Research subject
Pediatrics; Neurology; Psychiatry
Identifiers
URN: urn:nbn:se:umu:diva-144211DOI: 10.1038/pr.2018.35ISI: 000436345400009PubMedID: 29538361Scopus ID: 2-s2.0-85049120412OAI: oai:DiVA.org:umu-144211DiVA, id: diva2:1177820
Available from: 2018-01-26 Created: 2018-01-26 Last updated: 2018-09-21Bibliographically approved
In thesis
1. Neurodevelopment and cardiovascular risk in 7-year old children born with marginally low birth weight
Open this publication in new window or tab >>Neurodevelopment and cardiovascular risk in 7-year old children born with marginally low birth weight
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Being born preterm (<37+0 gestational weeks) or with low birth weight (LBW, <2500 g) has been associated with a number of adverse health outcomes later in life. Most studied are cardiovascular and neurodevelopmental consequences in those born preterm and with very LBW (<1500 g). However, a majority of LBW children are born with a birth weight between 2000 and 2500 g, herein referred to as marginally LBW. The long-term risk profile for this substantially large group of children, is not known.

Aim: The aim of this study was to explore cardiovascular risk and neurocognitive development in marginally LBW children born in Sweden.

Method: This was originally a randomized controlled double-blinded trial aiming to explore the effects of iron supplementation in 285 children born with marginally LBW. The children were randomized to receive 0 mg/kg/day (placebo), 1 mg/kg/day or 2 mg/kg/day of iron supplements between 6 weeks and 6 months of age. As part of this observational follow-up study, 95 matched control children born with normal birth weight (NBW, 2501-4500 g) were recruited former to the first follow-up at 3.5-years. This thesis presents data from a follow-up at 7 years, including anthropometric data, blood pressure (BP), body composition (from a dual-energy X-ray absorptiometry) and laboratory markers of cardiovascular risk such as fasting glucose, insulin and lipid profile. Also, the children were tested using the validated neurocognitive tests WISC-IV (Wechsler Intelligence Scale for Children), Beery VMI (Beery-Buktenica developmental test of visual-motor integration) and TEA-Ch (Test of Everyday Attention for Children).

Results: The marginally LBW children were thinner (15.1 vs 15.5 kg/m2, p=0.046), shorter (122.4 vs 124.9 cm, p=0.001) and had a higher prevalence of underweight (10.7 % vs 2.9 %, p=0.050) compared to their NBW peers. In addition, the LBW children had a significantly larger prevalence of high fasting insulin levels (>90th percentile of the control group). The subgroup of children born small for gestational age (SGA) also had a higher mean fasting glucose level, compared to NBW controls. There were no differences in prevalence of overweight or having an adverse lipid profile between the groups. The marginally LBW children who had received iron supplements, as part of the original intervention trial, had approximately 2 mmHg lower systolic BP, compared to the placebo group (p=0.026). The odds of having a high BP was lowered by 68 % (OR 0.32; CI 0.11-0.96) in the supplemented groups.

The marginally LBW children had 3.1 points lower verbal comprehension IQ (p=0.004), 3.5 points lower Beery VMI (p=0.028) and poorer selective attention compared to those born with NBW.

Conclusions: The marginally LBW children were thinner and shorter and they had an imbalanced glucose and insulin homeostasis, particularly those born SGA. Early iron supplements lowered systolic BP to a level similar to controls, suggesting a novel hypothesis regarding a long term protective effect against adverse programming. Finally, the children born with marginally LBW had poorer neurocognitive outcomes, prompting particular attention at school age.

Place, publisher, year, edition, pages
Umeå: Umeå Universitet, 2018. p. 83
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1943
Keywords
Low birth weight, early programming, accelerated catch-up growth, neurodevelopment, cardiovascular risk
National Category
Pediatrics
Research subject
Pediatrics
Identifiers
urn:nbn:se:umu:diva-144215 (URN)978-91-7601-814-9 (ISBN)
Public defence
2018-02-23, Sal D, unodT9, by 1D, plan 9, NUS, Norrlands Universitetssjukhus, Umeå, 09:00 (English)
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Supervisors
Available from: 2018-02-02 Created: 2018-01-26 Last updated: 2018-06-09Bibliographically approved

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Starnberg, JosefineNorman, MikaelWestrup, BjörnDomellöf, MagnusBerglund, Staffan K

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