First lessons 6 13

First Lessons
The Value of Healthy Regulation for Parent & Baby
Paige Terrien Church, MD
Neonatologist & Developmental Behavioral
Pediatrician
Assistant Professor, Paediatrics

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DisclosureDisclosure
• I have no actual or potential conflict of interest in relationI have no actual or potential conflict of interest in relation
to this program.to this program.
• I also assume responsibility for ensuring the scientificI also assume responsibility for ensuring the scientific
validity, objectivity, and completeness of the content ofvalidity, objectivity, and completeness of the content of
my presentationmy presentation
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ObjectivesObjectives
At the end of this session you will be able to:At the end of this session you will be able to:
1.1. Understand neurosensory development and criticalUnderstand neurosensory development and critical
periodsperiods
2.2. Explain normal attachmentExplain normal attachment
3.3. Recognize impact of interrupted neurodevelopment onRecognize impact of interrupted neurodevelopment on
outcomeoutcome

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Introduction
• “It is easier to build
strong children than
to repair broken men.”
(Frederick Douglas)
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ProblemProblem
• 50-70% of very preterm infants have difficulty50-70% of very preterm infants have difficulty
with school performancewith school performance
• Proposed factor: complex amalgam of minorProposed factor: complex amalgam of minor
challengeschallenges
– BehavioralBehavioral
– Motor (fine, gross, visual)Motor (fine, gross, visual)
– Cognitive (intellect, processing)Cognitive (intellect, processing)

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Behavioral PhenotypeBehavioral Phenotype
• Describes a constellation of behavioral,Describes a constellation of behavioral,
cognitive, motor, and social difficulties observedcognitive, motor, and social difficulties observed
in a population with a common biologicalin a population with a common biological
disorderdisorder
• Premature survivors have a phenotypePremature survivors have a phenotype
– Common biological disorder=alterations inCommon biological disorder=alterations in
brain developmentbrain development
Hodapp RM, Fidler DJ. Special Education and Genetics: Connections for the 21Hodapp RM, Fidler DJ. Special Education and Genetics: Connections for the 21stst
Century. The J Spec EducCentury. The J Spec Educ
1999; 33: 130-137.1999; 33: 130-137.

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Behavioral Phenotype of PrematurityBehavioral Phenotype of Prematurity
• Majority of preterms withMajority of preterms with
resolution of medicalresolution of medical
issues by school ageissues by school age
• Motor delays commonMotor delays common
• Dystonia=early signDystonia=early sign
• Breslau N, Chilcoat EO, Johnson EO, Andreski P, Lucia VC.Breslau N, Chilcoat EO, Johnson EO, Andreski P, Lucia VC.
Neurologic Soft Signs and Low Birthweight: Their Association andNeurologic Soft Signs and Low Birthweight: Their Association and
Neuropsychiatric Implications. Biol Psychiatry 2000; 47: 71-79.Neuropsychiatric Implications. Biol Psychiatry 2000; 47: 71-79.
• Bracewell M, Marlowe N. Patterns of Motor Disability in the VeryBracewell M, Marlowe N. Patterns of Motor Disability in the Very
Preterm Children. Ment Dev Disabil Res Rev 2002; 8: 241-248.Preterm Children. Ment Dev Disabil Res Rev 2002; 8: 241-248.
• Goyen T-A, Lui K. Developmental Coordination Disorder inGoyen T-A, Lui K. Developmental Coordination Disorder in
“apparently normal” schoolchildren born extremely preterm. Arch Dis“apparently normal” schoolchildren born extremely preterm. Arch Dis
Child 2009; 94: 298-302.Child 2009; 94: 298-302.

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• Social emotional dys-regulationSocial emotional dys-regulation
greater in pretermgreater in preterm
– LabileLabile
• Internalizing conditionsInternalizing conditions
– AnxietyAnxiety
– WithdrawnWithdrawn
– Socially awkwardSocially awkward
– Bhutta AT, Cleves MA, Casey PH, Cradock MM, Anand KJS. Cognitive andBhutta AT, Cleves MA, Casey PH, Cradock MM, Anand KJS. Cognitive and
Behavioral Outcomes of School-Aged Children Who Were Born Preterm: ABehavioral Outcomes of School-Aged Children Who Were Born Preterm: A
Meta-Analysis. JAMA. 2002; 288: 728-737.Meta-Analysis. JAMA. 2002; 288: 728-737.
– Spittle AJ, Treyvaud K, Doyle LW,Spittle AJ, Treyvaud K, Doyle LW, et alet al. Early Emergence of Behavior and Social-. Early Emergence of Behavior and Social-
Emotional Problems in the Very Preterm Infants. J. Am Acad Child AdolescEmotional Problems in the Very Preterm Infants. J. Am Acad Child Adolesc
Psychiatry 2009; 48: 909-918.Psychiatry 2009; 48: 909-918.

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• Preterms with greater:Preterms with greater:
– Executive dysfunctionExecutive dysfunction
– Hyperactivity, inattentionHyperactivity, inattention
– ADHD/ADDADHD/ADD
– Bhutta AT, Cleves MA, Casey PH, Cradock MM, Anand KJS. Cognitive and Behavioral Outcomes ofBhutta AT, Cleves MA, Casey PH, Cradock MM, Anand KJS. Cognitive and Behavioral Outcomes of
School-Aged Children Who Were Born Preterm: A Meta-Analysis. JAMA. 2002; 288: 728-737.School-Aged Children Who Were Born Preterm: A Meta-Analysis. JAMA. 2002; 288: 728-737.
– Anderson PJ, Doyle LW, and Victorian Infant Collaborative Study Group. Executive Functioning in School-Anderson PJ, Doyle LW, and Victorian Infant Collaborative Study Group. Executive Functioning in School-
Aged Children Who Were Born Very Preterm or With Extremely Low Birth Weight in the 1990’s. PediatricsAged Children Who Were Born Very Preterm or With Extremely Low Birth Weight in the 1990’s. Pediatrics
2004; 114: 50-57.2004; 114: 50-57.

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• Generally average abilities in:Generally average abilities in:
– ReceptiveReceptive
– ExpressiveExpressive
• Subtle difficulties common with:Subtle difficulties common with:
– SyntaxSyntax
– Complexity of language used & understoodComplexity of language used & understood
Foster-Cohen S, Edgin JO, Champion PR, Woodward LJ. Early delayed language in very preterm infants:Foster-Cohen S, Edgin JO, Champion PR, Woodward LJ. Early delayed language in very preterm infants:
Evidence from the MacArthur-Bates CDI. J Child Lang 2007; 34: 655-675.Evidence from the MacArthur-Bates CDI. J Child Lang 2007; 34: 655-675.
Foster-Cohen SH, Friesen MD, Champion PR, Woodward LJ. High Prevalence/Low Severity Language Delay inFoster-Cohen SH, Friesen MD, Champion PR, Woodward LJ. High Prevalence/Low Severity Language Delay in
Preschool Children Born Very Preterm. J Dev Behav Pediatr 2010; 31: 658-667.Preschool Children Born Very Preterm. J Dev Behav Pediatr 2010; 31: 658-667.

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• Cognitive skills historically regarded as bestCognitive skills historically regarded as best
marker of school successmarker of school success
– Actually only a piece of puzzleActually only a piece of puzzle
• Preterm at particular risk with:Preterm at particular risk with:
– Lower IQ than termLower IQ than term
– More likely to have borderline IQMore likely to have borderline IQ
Marlowe NM, Wolke DM, Bracewell MA et al. Neurologic and Developmental Disability at SixMarlowe NM, Wolke DM, Bracewell MA et al. Neurologic and Developmental Disability at Six
Years of Age after Extremely Preterm Birth. NEJM 2005; 353: 9-19.Years of Age after Extremely Preterm Birth. NEJM 2005; 353: 9-19.
Whitfield MF, Grunau RV, Holsti L. Extremely premature (Whitfield MF, Grunau RV, Holsti L. Extremely premature (<< 800g) schoolchildren: multiple areas800g) schoolchildren: multiple areas
of hidden disability. Arch Dis Child 1997; 77: F85-90.of hidden disability. Arch Dis Child 1997; 77: F85-90.
Saigal S, den Ouden L, Wolke D,Saigal S, den Ouden L, Wolke D, et alet al. School Age Outcomes in Children Who Were Extremely. School Age Outcomes in Children Who Were Extremely
Low Birth Weight From Four International Population-Based Cohorts. Pediatrics 2003; 112:Low Birth Weight From Four International Population-Based Cohorts. Pediatrics 2003; 112:
943-950.943-950.

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• Challenges with:
– Language comprehension and expression
• (Verbal and nonverbal communication)
– Spatial relationships
– Eye contact
– Impulse control
– Organizational abilities
– Physical attributes
– Motor coordination
– Anxiety (separation anxiety)
– Emotional lability
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NeurodevelopmentNeurodevelopment
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Neurodevelopment
• Interplay between intrinsic brain development andInterplay between intrinsic brain development and
experienceexperience
• Intrinsic: driven by genetic code with proliferation andIntrinsic: driven by genetic code with proliferation and
migrationmigration
• Critical cellsCritical cells
– Subplate neuronsSubplate neurons
– Pre-oligodendrocytesPre-oligodendrocytes
– External granule cellsExternal granule cells
• Kolb B, Gibb R. Brain Plasticity and Behaviour in the Developing Brain. J Can Acad Child Adolesc Psychiatry 2011; 20: 265-276.Kolb B, Gibb R. Brain Plasticity and Behaviour in the Developing Brain. J Can Acad Child Adolesc Psychiatry 2011; 20: 265-276.
• Volpe JJ. Brain injury in preterm infants: a complex amalgam of destructive and developmental disturbances. J Lancet 2009; 8: 110-124.Volpe JJ. Brain injury in preterm infants: a complex amalgam of destructive and developmental disturbances. J Lancet 2009; 8: 110-124.
• Volpe JJ. Subplate Neurons—Missing Link in Brain Injury in the Premature Infant? Pediatrics 1996; 97: 112-113.Volpe JJ. Subplate Neurons—Missing Link in Brain Injury in the Premature Infant? Pediatrics 1996; 97: 112-113.
• Volpe JJ. Cerebellum of the Premature Infant: Rapidly Developing, Vulnerable, Clinically Important. J Child Neurol 2009; 24: 1085-1104.Volpe JJ. Cerebellum of the Premature Infant: Rapidly Developing, Vulnerable, Clinically Important. J Child Neurol 2009; 24: 1085-1104.
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Neurodevelopment
• Extrinsic element=Neuronal plasticity
• Experience expectant development
– Experience leads to pruning
– Critical period with early synapse development
• Experience dependent development
– Sensitive period with synapse formation/pruning
– Specific regions of brain
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Neurosensory developmentNeurosensory development
• Specific sequence
– TactileVestibularChemicalAuditoryVisual
• Interrelated and redundant nature of sensory perception
– Contributes to later perceptual organization
• Impact of stimulation mediated by:
– Timing
– Developmental trajectory
• Lickliter R. The Integrated Development of Sensory Development. Clin Perinatol 2011;38:591-603.
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Neurodevelopment
Attachment
• Begins in utero through sensory input
– Sounds & smells
• Wired to provide rapid learning
• Early purpose=survival
– Keep infant close to mother
– Guide brain development
• Provides secure base for future exploration
• Sullivan R, Perry R, Sloan A, Kleinhaus K, Burtchen N. Infant Bonding and Attachment to the Caregiver: Insights from Basic and Clinical
Science. Clin Perinatol 2011;38:643-55.
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Neurodevelopment
Impact of Prematurity
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Neurodevelopment
• Interruption of normal neurosensory developmentInterruption of normal neurosensory development
• Developmental susceptibilityDevelopmental susceptibility
– Plastic system at critical pointPlastic system at critical point
• Injury or atypical inputInjury or atypical input
• Epigenetic changesEpigenetic changes

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Neurodevelopment
• ““Normal” head ultrasound NOT guarantee ofNormal” head ultrasound NOT guarantee of
normal outcomenormal outcome
– 9% with CP9% with CP
– 25% with MDI less than 7025% with MDI less than 70
• Laptook AR, O’Shea TM, Shankaran S, Bhaskar B. Adverse Neurodevelopmental outcomes among extremelyLaptook AR, O’Shea TM, Shankaran S, Bhaskar B. Adverse Neurodevelopmental outcomes among extremely
low birth weight infants with a normal head ultrasound: prevalence and antecedents. Pediatrics. 2005; 115: 673-low birth weight infants with a normal head ultrasound: prevalence and antecedents. Pediatrics. 2005; 115: 673-
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Neurodevelopment
•3-4% with abnormality on HUS3-4% with abnormality on HUS
•20-65% with abnormality on MRI20-65% with abnormality on MRI
Inder TE, Wells SJ, Mogridge NB, Spencer C, Volpe JJ. Defining the Nature of the Cerebral Abnormalities in theInder TE, Wells SJ, Mogridge NB, Spencer C, Volpe JJ. Defining the Nature of the Cerebral Abnormalities in the
Premature Infant: A Qualitative Magnetic Resonance Imaging Study. J Pediatr 2003; 143: 171-179.Premature Infant: A Qualitative Magnetic Resonance Imaging Study. J Pediatr 2003; 143: 171-179.

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Neurodevelopment
• Developmental vulnerability with preterm birthDevelopmental vulnerability with preterm birth
• Critical cells in preterm brain lack protectionCritical cells in preterm brain lack protection
from injuryfrom injury
– Subplate neuronsSubplate neurons
– InterneuronsInterneurons
– Pre-oligodendrocytesPre-oligodendrocytes
– External granule cellsExternal granule cells
• Volpe JJ. Subplate Neurons—Missing Link in Brain Injury in the Premature Infant? Pediatrics 1996; 97: 112-113.Volpe JJ. Subplate Neurons—Missing Link in Brain Injury in the Premature Infant? Pediatrics 1996; 97: 112-113.
• Volpe JJ. Cerebellum of the Premature Infant: Rapidly Developing, Vulnerable, Clinically Important. J Child Neurol 2009; 24: 1085-1104.Volpe JJ. Cerebellum of the Premature Infant: Rapidly Developing, Vulnerable, Clinically Important. J Child Neurol 2009; 24: 1085-1104.

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Neurodevelopment
• Cell death via:Cell death via:
– NecrosisNecrosis
– ApoptosisApoptosis
• Can occur on:Can occur on:
– Macroscopic (IVH,Macroscopic (IVH,
PVL, PVHI)PVL, PVHI)
– Microscopic levelMicroscopic level
(diffuse injury)(diffuse injury)
• Volpe JJ. Brain injury in preterm infants: aVolpe JJ. Brain injury in preterm infants: a
complex amalgam of destructive andcomplex amalgam of destructive and
developmental disturbances. J Lancet 2009;developmental disturbances. J Lancet 2009;
8: 110-124.8: 110-124.

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Impact of PrematurityImpact of Prematurity
• Altered synaptogenesisAltered synaptogenesis
– Experience expectant versus experienceExperience expectant versus experience
dependentdependent
– Similar experience with different effectsSimilar experience with different effects
• Plasticity can be good or badPlasticity can be good or bad
• Neuronal Group Selection TheoryNeuronal Group Selection Theory

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Neurodevelopment
• Loss of controlled sensory exposure
• Alterations to timing (too much too soon, too little too
late)
– Impact perceptual organization
• Loss of redundancy
– Impacts selective attention, perceptual organization, learning
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Neuro-DevelopmentNeuro-Development
• End result is:End result is:
– Gray matter architecture distortedGray matter architecture distorted
– White matter connectivity alteredWhite matter connectivity altered
– Cerebellum under-developedCerebellum under-developed
• Leads toLeads to secondary cortical dysplasiasecondary cortical dysplasia
• Volpe JJ. Brain injury in preterm infants: a complex amalgam of destructive and developmentalVolpe JJ. Brain injury in preterm infants: a complex amalgam of destructive and developmental
disturbances. J Lancet 2009; 8: 110-124.disturbances. J Lancet 2009; 8: 110-124.
• Alyward GP. Neurodevelopmental Outcomes of Infants Born Prematurely. J Dev Behav PediatrAlyward GP. Neurodevelopmental Outcomes of Infants Born Prematurely. J Dev Behav Pediatr
2005; 26: 427-440.2005; 26: 427-440.

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Targets for InterventionTargets for Intervention
Luciana M. Cognitive development in children born preterm: Implications for theories of brain plasticity following early injury. DevelLuciana M. Cognitive development in children born preterm: Implications for theories of brain plasticity following early injury. Devel
Psychopathol 2003;15:1017-47Psychopathol 2003;15:1017-47

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Hadders-Algra M. The Neuronal Group Selection Theory: a framework to explain variation in normalHadders-Algra M. The Neuronal Group Selection Theory: a framework to explain variation in normal
development. Dev Med Child Neurol 2000;42:566-72.development. Dev Med Child Neurol 2000;42:566-72.

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Targets for Intervention: NICU
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“Kangaroo care is crucial for babies to grow and develop and is
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Targets for Intervention: NICUTargets for Intervention: NICU
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Targets for Intervention: NICUHack MB. Commentary: Care of Preterm Infants in the Neonatal Intensive Care Unit. Pediatrics 2009;123:1246.
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• Randomized controlled trial with standard care and family care
rooms (2 units)
• Family care resulted in:
– Decreased length of stay
– No effect on mortality
– Trend toward decreased BPD
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• Neuronal Group Selection Theory
– Nesting versus containment
• Skin to skin
• Cluster non-emergent care
• Pain management (non-pharmacological if possible)
• Family integrated care
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• Non-nutritive sucking
• Breast milk
• Holding with feeds (NG or PO)
• Environment
– Fosters family presence
– Sensory protection (ambient light exposure, sounds, smells)
• Primary nursing
– Infants can have up to 120 care providers in hospitalization
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Targets for Intervention
Neonatal Follow Up
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Neonatal Follow Up
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Neonatal Follow Up
• Follow up not only surveillance for outcomesFollow up not only surveillance for outcomes
– Need assessment, diagnosis and interventionNeed assessment, diagnosis and intervention
• Homework critical—small stepsHomework critical—small steps
• Reports with clear languageReports with clear language

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Neonatal Follow Up
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Neonatal Follow Up
• Awareness of statistics not equivalent to childAwareness of statistics not equivalent to child
becoming statisticbecoming statistic
• Should provide heightened surveillance andShould provide heightened surveillance and
attention to ‘small’ problemsattention to ‘small’ problems
• Constant contextualizationConstant contextualization

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Neonatal Follow Up
• Collaboration with schools criticalCollaboration with schools critical
• Parents need to be educated in positiveParents need to be educated in positive
advocacyadvocacy
– Education on transition to schoolsEducation on transition to schools
– Special education resourcesSpecial education resources
– Major morbidities and minor morbidities not mutuallyMajor morbidities and minor morbidities not mutually
exclusiveexclusive

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Neonatal Follow Up
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Future DirectionsFuture Directions
• Emphasis shift in NICUEmphasis shift in NICU
– Minimize stressMinimize stress
– Normalize environmental exposure-Parents idealNormalize environmental exposure-Parents ideal
environmentenvironment
• Extended follow up ideal model withExtended follow up ideal model with
collaboration with emphasis on interventioncollaboration with emphasis on intervention
• SpecializedSpecialized training essentialtraining essential

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Future DirectionsFuture Directions
• Ongoing research neededOngoing research needed
– Correlation to neuroimaging patternsCorrelation to neuroimaging patterns
– Neonatal care & impacts on outcomeNeonatal care & impacts on outcome
– OutcomesOutcomes
• Particularly School based and school interventions!Particularly School based and school interventions!
– Functional outcome measurements neededFunctional outcome measurements needed

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Thank You!Thank You!
• Sunnybrook Health Sciences CentreSunnybrook Health Sciences Centre
• Neonatal Follow Up ClinicNeonatal Follow Up Clinic
– Marion DeLand, RNMarion DeLand, RN
– Maureen Luther, PTMaureen Luther, PT
– Pat Maddalena, PNPPat Maddalena, PNP
– Laura Cooper, OTLaura Cooper, OT
– Rudaina Banihani, MD and Jessie VanDyk, MD (neonatalRudaina Banihani, MD and Jessie VanDyk, MD (neonatal
fellows)fellows)
– Vanessa Warsh, administratorVanessa Warsh, administrator
– Carol Grenade, administratorCarol Grenade, administrator

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SourcesSources
• Anderson PJ et al. Executive Functioning in School Aged Children Who Were Born Very Preterm or With Extremely Low Birth Weight in the 1990’s.Anderson PJ et al. Executive Functioning in School Aged Children Who Were Born Very Preterm or With Extremely Low Birth Weight in the 1990’s.
Pediatrics. 2004;114:50-57Pediatrics. 2004;114:50-57
• Anderson P, Doyle L. Neurobehavioral Outcomes of School Age Children Born Extremely Low Birth Weight or Very Preterm in the 1990’s. JAMA.Anderson P, Doyle L. Neurobehavioral Outcomes of School Age Children Born Extremely Low Birth Weight or Very Preterm in the 1990’s. JAMA.
2003;289:3264-3272.2003;289:3264-3272.
• Aylward GP. ADHD in Children with Disabilities: Etiologic, Diagnostic, and Psychopharmacologic Issues. Lecture, AACPDM, September 2005.Aylward GP. ADHD in Children with Disabilities: Etiologic, Diagnostic, and Psychopharmacologic Issues. Lecture, AACPDM, September 2005.
• Aylward GP. Cognitive and Neuropsychological Outcomes: More than IQ Scores. Mental Retardation and Developmental Disabilities ResearchAylward GP. Cognitive and Neuropsychological Outcomes: More than IQ Scores. Mental Retardation and Developmental Disabilities Research
Reviews. 2002;8:234-240.Reviews. 2002;8:234-240.
• Aylward GP. Neurodevelopmental Outcomes of Infants Born Prematurely. JDBP. 2005;26:427-440.Aylward GP. Neurodevelopmental Outcomes of Infants Born Prematurely. JDBP. 2005;26:427-440.
• Aylward GP. Presidential Address. Prediction of Function from Infancy to Early Childhood: Implications for Pediatric Psychology. Journal of PediatricAylward GP. Presidential Address. Prediction of Function from Infancy to Early Childhood: Implications for Pediatric Psychology. Journal of Pediatric
Psychology. 2004;29:555-564Psychology. 2004;29:555-564
• Berlin CI et al. Auditory neuropathy/dyssynchrony: Its diagnosis and management. Pediatric Clinics of North America. 2003;50:331-340.Berlin CI et al. Auditory neuropathy/dyssynchrony: Its diagnosis and management. Pediatric Clinics of North America. 2003;50:331-340.
• Bracewell M et al. Patterns of Motor Disability in Very Preterm Children. Mental Retardation and Developmental Disabilities Research Reviews.Bracewell M et al. Patterns of Motor Disability in Very Preterm Children. Mental Retardation and Developmental Disabilities Research Reviews.
2002;8:241-248.2002;8:241-248.
• Brandt I et al. Transient abnormal neurologic signs (TANS) in a longitudinal study of very low birth weight preterm infants. Early Human Development.Brandt I et al. Transient abnormal neurologic signs (TANS) in a longitudinal study of very low birth weight preterm infants. Early Human Development.
2000;59:107-126.2000;59:107-126.
• Breslau N et al. Neurologic Soft Signs and Low Birth Weight: Their Association and Neuropsychiatric Implications. Biol Psychiatry. 2000;47:71-79Breslau N et al. Neurologic Soft Signs and Low Birth Weight: Their Association and Neuropsychiatric Implications. Biol Psychiatry. 2000;47:71-79
• deGraaf-Peters VB, Hadders-Algra M. Ontogeny of the human central nervous system: What is happening when? Early Human Development 2006;deGraaf-Peters VB, Hadders-Algra M. Ontogeny of the human central nervous system: What is happening when? Early Human Development 2006;
82:257-266.82:257-266.
• Delobel-Ayoub M et al. Behavioral Problems and Cognitive Performance at 5 Years of Age After Very Preterm Birth: The EPIPAGE Study. Pediatrics.Delobel-Ayoub M et al. Behavioral Problems and Cognitive Performance at 5 Years of Age After Very Preterm Birth: The EPIPAGE Study. Pediatrics.
2009;6:1485-1492.2009;6:1485-1492.
• Goyen T-A. Developmental Coordination Disorder in ‘Apparently Normal’ School Children Born Extremely Preterm.Goyen T-A. Developmental Coordination Disorder in ‘Apparently Normal’ School Children Born Extremely Preterm.
• Hack M et al. Poor Predictive Validity of BSID for Cognitive Function of Extemely Low Birth Weight Children at School Age. Pediatrics. 2005;116:333-Hack M et al. Poor Predictive Validity of BSID for Cognitive Function of Extemely Low Birth Weight Children at School Age. Pediatrics. 2005;116:333-
341.341.
• Hack M. School Age Outcomes in Children with Birth Weights Under 750 g. NEJM. 1994;331:753-759.Hack M. School Age Outcomes in Children with Birth Weights Under 750 g. NEJM. 1994;331:753-759.
• Harris LL et al. School Readiness. Up to Date. 2010.Harris LL et al. School Readiness. Up to Date. 2010.
• High PC et al. School Readiness. Pediatrics 2008;121:e1008-e1015.High PC et al. School Readiness. Pediatrics 2008;121:e1008-e1015.
• Inder TE et al. Defining the Nature of the Cerebral Abnormalities in the Premature Infant: A Qualitative Magnetic Resonance Imaging Study. Journal ofInder TE et al. Defining the Nature of the Cerebral Abnormalities in the Premature Infant: A Qualitative Magnetic Resonance Imaging Study. Journal of
Pediatrics. 2003;171-179.Pediatrics. 2003;171-179.
• Klein N, Hack M, Gallagher J, Fanaroff AA. Preschool Performance of Childrein with Normal Intelligence Who Were very Low-Birth-Weight Infants.Klein N, Hack M, Gallagher J, Fanaroff AA. Preschool Performance of Childrein with Normal Intelligence Who Were very Low-Birth-Weight Infants.
Pediatrics 1985;75:513-37.Pediatrics 1985;75:513-37.
• Kuban KCK et al. Positive Screening on the Modified Checklist for Autism in Toddlers (M-CHAT) in Extremely Low Birth Gestational Age Newborns.Kuban KCK et al. Positive Screening on the Modified Checklist for Autism in Toddlers (M-CHAT) in Extremely Low Birth Gestational Age Newborns.
Journal of Pediatrics. In press.Journal of Pediatrics. In press.

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SourcesSources
• Laptook AR et al. Adverse Neurodevelopmental outcomes among extremely low birth weight infants with a normal head ultrasound:Laptook AR et al. Adverse Neurodevelopmental outcomes among extremely low birth weight infants with a normal head ultrasound:
prevalence and antecedents. Pediatrics. 2005;115:673-680.prevalence and antecedents. Pediatrics. 2005;115:673-680.
• Lian WB, Ying SHK et al. Preschool Teachars’ Knowledge, attitudes, and practices on childhood developmental and behaviouralLian WB, Ying SHK et al. Preschool Teachars’ Knowledge, attitudes, and practices on childhood developmental and behavioural
disorders in Singapore. J. of Paediatrics and Child Health. 2008;44:187-194.disorders in Singapore. J. of Paediatrics and Child Health. 2008;44:187-194.
• Limperopoulos C et al. Positive Screening for Autism in Ex-Preterm Infants: Prevalence and Risk Factors. Pediatrics. 2008;121:758-765.Limperopoulos C et al. Positive Screening for Autism in Ex-Preterm Infants: Prevalence and Risk Factors. Pediatrics. 2008;121:758-765.
• Lowe J et al. Emotional Regulation and Its Impact on Development in the Extremely Low Birth Weight Infants. Developmental andLowe J et al. Emotional Regulation and Its Impact on Development in the Extremely Low Birth Weight Infants. Developmental and
Behavioral Pediatrics. 2005;26:209-213.Behavioral Pediatrics. 2005;26:209-213.
• Marlow N et al. Motor and Executive Function at 6 Years of Age After Extremely Preterm Birth. Pediatrics. 2007;120:793-804.Marlow N et al. Motor and Executive Function at 6 Years of Age After Extremely Preterm Birth. Pediatrics. 2007;120:793-804.
• Marlow N et al. Neurologic and Developmental Disability at 6 Years After Extremely Preterm Birth. NEJM. 2005;352:9-19.Marlow N et al. Neurologic and Developmental Disability at 6 Years After Extremely Preterm Birth. NEJM. 2005;352:9-19.
• McCormick MC. The Outcomes of Very Low Birth Weight Infants: Are We Asking the Right Questions? Pediatrics. 1997;99:869-876.McCormick MC. The Outcomes of Very Low Birth Weight Infants: Are We Asking the Right Questions? Pediatrics. 1997;99:869-876.
• Ment LR et al. Longitudinal Brain Volume Changes in Preterm and Term Control Subjects During Late Childhood and Adolescence.Ment LR et al. Longitudinal Brain Volume Changes in Preterm and Term Control Subjects During Late Childhood and Adolescence.
Pediatrics. 2009;123:503-511.Pediatrics. 2009;123:503-511.
• Miller KJ. Executive Functions. Pediatric Annals. 2005;34:311-317.Miller KJ. Executive Functions. Pediatric Annals. 2005;34:311-317.
• Mulder H, Pitchford N et al. Processing Speed and Working Memory underlie academic attainment in very preterm children. Archives ofMulder H, Pitchford N et al. Processing Speed and Working Memory underlie academic attainment in very preterm children. Archives of
Disease in Childhood, Fetal Neonatal Edition. 2010.Disease in Childhood, Fetal Neonatal Edition. 2010.
• Patrianakos-Hoobler A, Msall ME et al. Predicting school readiness from neurodevelopmental assessments at age 2 years afterPatrianakos-Hoobler A, Msall ME et al. Predicting school readiness from neurodevelopmental assessments at age 2 years after
respiratory distress syndrome in infants born preterm. Developmental Medicine & Child Neurology. 2010;52:379-385.respiratory distress syndrome in infants born preterm. Developmental Medicine & Child Neurology. 2010;52:379-385.
• Roberts G, Bellinger D et al. A Cumulative Risk Factor Model for Early Identification of Academic Difficulties in Premature and Low BirthRoberts G, Bellinger D et al. A Cumulative Risk Factor Model for Early Identification of Academic Difficulties in Premature and Low Birth
Weight Infants. Maternal Child Health Journal. 2007;11:161-172.Weight Infants. Maternal Child Health Journal. 2007;11:161-172.
• Saigal S. School-Age Outcomes in Children Who Were Extremely Low Birth Weight From Four International Population-Based Cohorts.Saigal S. School-Age Outcomes in Children Who Were Extremely Low Birth Weight From Four International Population-Based Cohorts.
Pediatrics. 2003;112:943-950.Pediatrics. 2003;112:943-950.
• Samara M et al. Pervasive behavior problems at 6 years of age in a total population sample of children born at <25 weeks of gestationSamara M et al. Pervasive behavior problems at 6 years of age in a total population sample of children born at <25 weeks of gestation
(EPICure). Pediatrics. 2008;122:562-573.(EPICure). Pediatrics. 2008;122:562-573.
• Spittle AJ et al. Early emergence of behavior and social-emotional problems in the very preterm infants. J. Am. Acad Child Adoles.Spittle AJ et al. Early emergence of behavior and social-emotional problems in the very preterm infants. J. Am. Acad Child Adoles.
Psychiatry. 2009;909-917.Psychiatry. 2009;909-917.
• Volpe JJ. Brain injury in premature infants: a complex amalgam of destructive and developmental disturbances. The Lancet. 2009;8:110-Volpe JJ. Brain injury in premature infants: a complex amalgam of destructive and developmental disturbances. The Lancet. 2009;8:110-
124.124.
• Woodward LJ et al. Neonatal MRI to Predict Neurodevelopmental Outcomes in Preterm Infants. NEJM. 2006;355:685-694.Woodward LJ et al. Neonatal MRI to Predict Neurodevelopmental Outcomes in Preterm Infants. NEJM. 2006;355:685-694.

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