Biomedical subjects

H Smolders-de Haas

Publications and source records attributed to H Smolders-de Haas.

7 recordsLinked to original sources

PubMed1999

Interobserver variability of the neurological optimality score.

OBJECTIVE: To assess the interobserver reliability of the neurological optimality score. STUDY DESIGN: The neurological optimality score of 21 full term healthy, neurologically normal newborn infants was determined by two well trained observers. RESULTS: The interclass correlation coefficient was 0.31. Kappa for optimality (score of 58 or higher) was 0.19. A systematic difference of 1.3 points between the two observers was present. CONCLUSIONS: The interobserver variability of the neurological optimality score of the newborn infant is substantial. The subtle judgement of elicited responses as optimal or non-optimal proved to be especially critical in this concordance study. A difference of at least two points in the score is considered as a valid endpoint for comparative studies. If two or more observers are involved in the neurological examination of the newborn infant in a study to assess influences on perinatal morbidity, frequent re-instruction sessions are recommended.

Birth Weight↗

PubMed1999

School performance and behaviour in extremely preterm growth-retarded infants.

OBJECTIVE: To describe school performance and behaviour of extremely preterm, growth-retarded infants. DESIGN: Cohort study at two tertiary care centres. Included were all surviving, singleton infants (N= 127) with fetal growth retardation due to placental insufficiency. All were delivered by caesarean section because of signs of fetal distress before the beginning of labour at a gestational age of 26 to 32 weeks during the years 1984-1989. Main outcome measures were special education, mainstream education below the appropriate age level and behaviour according to attention-deficit hyperactivity criteria at school age (4 1/2-10 1/2 yrs). The children were divided into two subgroups according to age at follow-up (> or =7 1/2 and <7 1/2 yr). A logistic regression analysis was performed with special school or repeating a grade and behavioural disturbance as dependent variables and gestational age, birth weight, sex of the infant, neonatal complications (intra cerebral haemorrhage, respiratory distress syndrome, bronchopulmonary dysplasia or sepsis), age category at follow-up and sociodemographic factors as independent variables. RESULTS: 114 (90%) had a complete follow-up. Special education was found in 14% of the assessed children. More children in the older age group than in the younger age group were placed in special school (20% versus 10%). Behavioural problems were scored in 39% of the assessed children attending mainstream education. Special education was related to neonatal complications (bronchopulmonary dysplasia), behavioural problems to the absence of either parent. CONCLUSION: This specific group of growth-retarded children is at serious disadvantage for adequate performance in school, although the incidence of special education and behavioural problems was comparable to other preterm infants. Both special education and behavioural problems were not related to obstetric variables as gestational age and/or birth weight.

Child↗

PubMed1999

Vaginal delivery compared with caesarean section in early preterm breech delivery: a comparison of long term outcome.

OBJECTIVE: To determine the optimum mode of delivery of the early preterm fetus in breech presentation. DESIGN: Retrospective comparison of two cohorts of preterm breech fetus. SETTING: Two tertiary care centres: at one centre the preferred management for preterm breech presentation was vaginal delivery; at the other centre, the preferred method was caesarean section. POPULATION: All singleton infants delivered after breech presentation from 1984 through 1989, at a gestational age of 26 to 31 weeks. Those with lethal congenital abnormalities, placenta praevia, placental abruption, fetal death or fetal distress before the onset of labour were excluded. MAIN OUTCOME MEASURES: Survival without disability or handicap documented at two years corrected age. The influence of a number of relevant variables on this outcome was assessed by logistic regression analysis. RESULTS: There was no difference in survival without disability or handicap between the centres (odds ratio 1.5, 95% CI 0.6-3.9 vaginal delivery compared with caesarean section). Survival without disability or handicap was positively influenced by increasing birthweight and corticosteroids > 24 h before birth, and negatively influenced by footling presentation. CONCLUSION: A policy of caesarean section for early preterm (26-31 weeks) breech delivery is not associated with increased survival without disability or handicap.

Adult↗

PubMed1997

Influence of obstetric management on outcome of extremely preterm growth retarded infants.

AIM: To describe the long term outcome of extremely preterm growth retarded infants in relation to obstetric management and various perinatal events. METHODS: A cohort study was undertaken in two tertiary care centres with different obstetric management. All infants with fetal growth retardation due to placental insufficiency and resulting in fetal distress at 26 to 32 weeks of gestation, were included for the years 1984-89. Main outcome measures were impairment, disability, or handicap at 2 years corrected age and at school age (4 1/2 to 10 1/2 years). RESULTS: One hundred and twenty five (98%) were followed up until 2 years corrected age in the outpatient department; 114 (90%) were assessed at school age. Impairments were found in 37% and disabilities or handicaps in 9% of the assessed infants, with no difference between centres. All disabled or handicapped children had already been identified by 2 years corrected age. CONCLUSIONS: Disability or handicap were related to neonatal complications (intracerebral haemorrhage or bronchopulmonary dysplasia) and not to obstetric variables, thus making antenatal prediction impossible. The incidence of disability or handicap in these growth retarded infants was comparable with that of other preterm infants.

Bronchopulmonary Dysplasia↗

PubMed1990

Psychological development of children who were treated antenatally with corticosteroids to prevent respiratory distress syndrome.

Potential side effects of antenatal administration of corticosteroids to prevent neonatal respiratory distress syndrome were studied in 10- to 12-year-old children whose mothers had participated in a randomized, double-blind, placebo-controlled trial of betamethasone. Aspects of the children's intellectual and motor development, school achievement, and social-emotional functioning were investigated. There were no differences between the corticoid group and the placebo group on these variables, nor were there more children with learning difficulties and behavioral disturbances in either of the groups.

Betamethasone↗

PubMed1990

Physical development and medical history of children who were treated antenatally with corticosteroids to prevent respiratory distress syndrome: a 10- to 12-year follow-up.

Potential side effects of antenatal administration of corticosteroids to prevent neonatal respiratory distress syndrome were studied in 10- to 12-year-old children whose mothers had participated in a randomized, double-blind, placebo-controlled trial of betamethasone. The children had a general physical examination; parents were interviewed about the medical history of their child with special attention to infectious diseases; growth data were collected; and a developmental neurological examination, an ophthalmological examination, and a lung function test were conducted. In the corticosteroid group significantly more hospital admissions because of infectious diseases during the first years of life were reported. On the other variables no differences between the corticoid and the placebo groups were found.

Betamethasone↗

PubMed1977

Effects of glucocorticoids during pregnancy on the outcome of the children directly after birth and in the long run.

We studied 17 mothers and the outcome of their 34 pregnancies. The purpose of this retrospective study was to determine possible adverse effects on growth of prolonged use of glucocorticoids, which have been recommended for short-term use in the prevention of respiratory distress syndrome (Liggins). There was no effect on duration of pregnancy; no congenital abnormalities were seen in this small group of children when corticoids were used during the whole pregnancy. There was a slight decrease in birth weight and placenta weight and, when known, also in length in almost every case. However, after long-term follow-up all of these children except 1 showed a catch-up growth and were slightly above normal. Their neurological and mental development was also normal except in 1 child who was born severely asphyxiated. We conclude from these results that there appears to be no adverse effect on later growth in the use of glucocorticoids during pregnancy. Therefore, it is unlikely that the short-term use of glucocorticoids as recommended by Liggins would have any influence on later growth.

Birth Weight↗