Biomedical subjects

N L Catanzaro

Publications and source records attributed to N L Catanzaro.

6 recordsLinked to original sources

PubMed1994

The Functional Independence Measure for Children (WeeFIM). Conceptual basis and pilot use in children with developmental disabilities.

Few tools are available to pediatricians for tracking and monitoring disability status in children. We describe the conceptual basis and pilot use of the Functional Independence Measure for Children (WeeFIM). Our pilot use of this instrument in children with limb deficiency, Down's syndrome, spina bifida, cerebral palsy, and extreme prematurity demonstrates that the WeeFIM is a valid measure for tracking disability in preschool age and middle childhood. The WeeFIM measures the impact of developmental strengths and difficulties on independence at home, in school, and in the community. This allows the pediatrician to prioritize interventions for enhancing comprehensive functional outcomes and supporting families.

Adaptation, Psychological↗

PubMed1993

Functional status of extremely preterm infants at kindergarten entry.

Functional status was formally assessed in 149 of 153 surviving members of an extremely preterm (< or = 28 weeks) birth cohort born at one tertiary center between 1983 and 1986. The children were observed in the completion of motor, speech and self-care tasks, and administered either the Vineland Daily Living Skills Scale (VDLS) or the Functional Independence Measure for children (WeeFIM). 31 children had major neurodevelopmental impairment. Only 5 per cent were considered to have severe functional limitation. The prevalence of functional limitation varied by definition: 11 children were limited using the WeeFIM instrument and 35 using the VDLS instrument. These findings suggest that the majority of extremely preterm children are functional at kindergarten entry, but will require continuous monitoring of academic skills.

Activities of Daily Living↗

PubMed1993

Predictors of mortality, morbidity, and disability in a cohort of infants < or = 28 weeks' gestation.

This study attempted to identify predictors for mortality, morbidity, disability, and educational handicap at age 4 years in a cohort of 194 infants born at 23 to 28 weeks' gestation at one regionalized tertiary center from 1983 to 1986. Forty-one infants died (21%); standardized neurodevelopmental and functional assessments were conducted on 149 of 153 (97%) survivors at a mean age of 52 months. Five significant predictors of death were identified with logistic regression analysis: gestational age 23 to 26 weeks, intraventricular hemorrhage grades 3 or 4, male gender, five-minute Apgar < or = 3, and absence of prophylactic calf lung surfactant extract. Significant predictors of neurodevelopmental morbidity included sepsis, male gender, and nonwhite race. Significant predictors of disability at age four included neurodevelopmental impairment and severe retinopathy of prematurity. Low socioeconomic status, nonwhite race and male gender were predictive of educational handicap. These findings suggest that outcomes may have distinct pathophysiologies. The role of biomedical events appears strongest for death.

Child, Preschool↗

PubMed1992

Kindergarten readiness after extreme prematurity.

OBJECTIVE: To assess kindergarten readiness among survivors of extreme prematurity and to identify predictors of special education requirements. DESIGN: Historic cohort design. SETTING: Regionalized tertiary pediatric center. PARTICIPANTS: One hundred forty-nine (97%) of 153 children who were alive at follow-up (mean +/- SD age, 52.7 +/- 9.9 months). SELECTION PROCEDURES: Study cohort included infants (gestation, 23 to 28 weeks), born between 1983 and 1986 (N = 194), who were alive at follow-up (N = 153, 79% survival). INTERVENTIONS: None. MEASUREMENTS AND RESULTS: Standardized neurodevelopmental and psychometric evaluations were administered by a multidisciplinary team that was blinded to the neonatal course. Thirty-one children (21%) had major neurodevelopmental impairments. By using the McCarthy Scales of Children's Abilities for children free of major impairments, 61 (63%) had one or more minor neurodevelopmental impairments noted. Half of the surviving children were thought to require special education resources at kindergarten entry. Multivariate logistic regression identified three significant predictors of special education: low socio-economic status, nonwhite race, and male gender. CONCLUSIONS: Social and demographic variables were associated with minor neurodevelopmental impairments and special education requirements among extremely premature children. Continued developmental follow-up and targeted interventions to reduce the risk of educational underachievement appear to be warranted.

Child, Preschool↗

PubMed1991

Risk factors for major neurodevelopmental impairments and need for special education resources in extremely premature infants.

The purpose of this cohort study was to determine the incidence of and risk factors for major neurodevelopmental impairments among survivors of extreme prematurity. The study cohort comprised 100 infants born between 24 and 28 weeks of gestational age at one tertiary center from 1983 to 1984. Twenty-five infants (25%) died; 75 (75%) survived until follow-up (mean, 60 months). Standardized neurodevelopmental and psychometric assessments were performed in blind fashion on 68 of the 75 surviving children (91% follow-up). Informal assessments (parent, teacher, and physician reports) were obtained instead for seven (9%) children who had relocated outside of the area. Overall, 19 children (25%) had one or more major impairments: mental retardation, 9; cerebral palsy, 4; multiple impairments, 5; and blindness, 1. Despite a high prevalence of impairments, 95% of children (n = 71) were functionally independent [corrected]. Special educational resources were definitely necessary for seven (9%) and possibly needed for 36 (48%) additional children. Univariate analyses revealed four significant risk factors for cerebral palsy: hydrocephalus (relative risk = 12.2), grades III and IV intraventricular hemorrhage (relative risk = 5.8), 5-minute Apgar score lower than 7 (relative risk = 5.7), and bronchopulmonary dysplasia (relative risk = 5.5). Hydrocephalus was the only significant risk factor observed for mental retardation (relative risk = 5.4). Risk factors predicting a need for special education resources included sepsis (relative risk = 24.9), low socioeconomic status (relative risk = 16.3), and nonwhite race (relative risk = 3.0). Thus our data suggest that biomedical factors appear to confer the greatest risk of major impairments; sociodemographic factors appear to have a significant impact on educational risk in extremely premature infants who do not die. Continued follow-up with biomedical and developmental-social interventions appears warranted to decrease the risk of educational underachievement in this population.

Birth Weight↗

PubMedDate not supplied

Multivariate risks among extremely premature infants.

This study was designed to identify risk factors for mortality and morbidity of extremely premature infants born in the surfactant era. The study cohort included 194 infants born at < 29 weeks' gestation at one regional tertiary center between 1983 and 1986. Forty-one infants died. Blinded neurodevelopmental assessments were performed on 149 of 153 (97%) survivors at a mean age of 52 months. Thirty-one (21%) survivors had major impairments: 15 had mental retardation, 8 had multiple impairments, 7 had cerebral palsy, and 1 was blind. Logistic regression analysis identifies five significant risk factors for mortality: grade III or IV intraventricular hemorrhage, birth weight < 800 gm, 5-minute Apgar score < or = 3, male sex, and absence of surfactant therapy. Significant risk factors for any major impairment included sepsis (relative risks [RR] = 6.4), male sex (RR = 3.1), and nonwhite race (RR = 2.8). Hydrocephalus requiring shunting was a significant risk factor for cerebral palsy (RR = 16.4) and neonatal retardation (RR = 16.0). Nonwhite race (RR = 7.3), sepsis (RR = 6.8), and male sex (RR = 3.7) also were significant risk factors for mental retardation. Confirmation of these risk factors should facilitate development of targeted interventions for optimizing long-term outcome.

Blindness↗