Lecture 4. Preterm birth Flashcards
What is preterm birth?
Until which week do we actively try to keep a child alive?
What is a low birthweight?
Being born <37 weeks of gestation
24 weeks
<24 grams
Which weeks?
- Moderate to late
- Very preterm
- Extremely preterm
- Moderate to late: 32-37 weeks of gestation
- Very preterm: 28-32 weeks of gestation
- Extremely preterm: <28 weeks of gestation
What are 3 causes for preterm birth?
- Spontaneously preterm labors (45%)
- Premature Preterm Rupture Of the Membrane (PPPROM; 30%)
- Delivery because of maternal or fetal infections (25%)
What is retinopathy of prematurity? (medical risk of preterm birth)
Eye disease, associated with being on a ventilator for a prolonged period of time
What is the ToP program?
An intervention for children <32 weeks and/or <1500 g birth weight done shortly after discharge, involving a house visit within 2 weeks after discharge, continuing until the corrected age of 1 year with 12 house visits. This program is based on family centered care
Cognitive functioning (IQ) and preterm birth. What is the difference and what are risk factors?
And for extremely preterm children?
Preterm children have a 10.9 point lower IQ, with risk factors birthweight and gestational age (the lower these factors, the lower their IQ).
In very or extremely preterm children we see a larger IQ difference (12.9 points lower), and a risk factor for this is bronchopulmonary dysplasia (lung disease).
What problems in academic functions are there for preterm children? And what risk factor?
Moderate to large difference on mathematics, reading, and spelling, with risk factor bronchopulmonary dysplasia.
What problems in behavioral functions are there for preterm children?
Behavioral problems are the most pronounced, they have higher (subtle) attention problems, with an ADHD diagnosis often given. Also, they have a higher risk for anxiety disorders, depression, and ASD
What are the core EFs? (3x)
- Working memory: the ability to hold information in mind and manipulate this information
- Inhibition: the ability to inhibit a response
- Cognitive flexibility: the ability to flexibly adapt to change/reactions/behavior according to changing circumstances or rules
In what way does preterm birth affect brain development in a way that it is associated with EFs? (2x)
- It affects the white matter network integrity (EFs highly depend on this)
- It affects structures associated with EFs
Is there case of growing into deficit in preterm children, with regard to EFs?
No, the patterns of EF difficulties was pretty stable across childhood, so the difference between preterm and term children at the age of 4 was similar to the difference when they were 14.
Which 2 subtypes in behavioral functioning are identified?
- a ‘low problems subtype’: pretty normal funcitoning on all behavioral domains (75%)
- a ‘high problems across domains subtype’: high levels of problems in behavioral functioning and across all domains (25%)
What are risk factors for belonging in the ‘high problems across domains subtype’ of behavioral functioning?
1 risk factor, 1 factor that is not a risk factor, and 2 ‘comorbidity’ problems
- Lower parental education level was a risk factor
- Neonatal medical complications was not a risk factor, it was not the case that if you had more complications or a specific one, that you had a higher risk
- This high problem subtype also showed poor cognitive functioning (lower IQs) and poorer executive functioning (poorer WM and inhibition)
What is ‘PowerMove’?
A computerized training, mostly aimed at motor functioning, since preterm children also often show difficulties in motor functioning (both gross and fine), but some behavioral problems may result from problems with motor competence. It’s a game children can play in which they stand in front of a screen, with a camera registering them, and they have to do for example a game in which they have to cross to the other side with their hand.
There are some promising effects of EF trainings, especially for …?
Which training did we use to examine whether EF trainings are also beneficial for preterm children?
Was it effective?
CogMed Working Memory Training
The BrainGame Brian Training, developed to train all 3 core EFs
However, it was not effective in its current form (maybe because we examined 10 year-olds, but that in younger children it might work since they are still developing EFs).
