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Re: A commentary on the paper of Cooke and Foulder-Hughes

Dear Editor

Poor postnatal growth, especially of the head, was associated with increased levels of motor impairment at 7 years of age in children born with a gestational age of less then 32 weeks. The difference between head growth (circumference at 7 years and after birth) was related to outcome at 7 years. The study of Foulders-Hughes et al. described the developmental outcome, measured with the same tests and in the same 280 children, as in the study of Cooke, concluding that the lowest birthweight and most pretermn individuals tended to score the lowest. Though many factors has been related to outcome in preterm born children, the two different conclusions in the same study group is remarkable and confusing.

Recently, Brandt et al. described the relation between early postnatal energy intake (first 10 days) and the developmental/intelligence quotients in preterm born children at 6 years of age. In the study of Coocke head circumference in only 78% of the studied children in the first 7 days after birth could be analysed. We suggest that energy intake in the first week after birth also could be responsible for the difference in developmental outcome. Moreover, Cooke described the severity of illness in the preterm born children, discussing that the majority of infants did not had major medical disease. However, more then 50% of the investigated children had some degree of retinopathy of prematurity and 50% were mechanical ventilated. In our opinion, these figures are present in children with major problems during the neonatal period, such as frequently seen in preterm infants born with these gestational ages (23 - 32 weeks). The neonatal problems could have been translated to a medical scoring index, such as the Neonatal Medical Index of Korner et al. This index has been proved to predict neuromotor outcome in children born as high-risk preterm infants (Samsom et al.). Though both authors (Cooke and Foulder-Hughes) discussed the methodological limitations of their study, the conclusion they made should be taken with cautious.

References

1. Foulder-Hughes L, Coocke RWI. Motor, cognitive and behavioural disorders in children born very preterm. Dev Med Child Neurol 2003; 45: 97 -103.

2. Brandt I, Sticker EJ, Lentze MJ. Catch-up growth and head circumference of very low birth weight, small for gestational ager preterm infants and mental development to adulthood. J Pediatr 2003; 142: 463-8.

3. Korner AF, Stevenson DK, Forest T, et al. Preterm medical complications differentially affect neuroneurobehavioral functions: results from a new medical index. Infant Behav Dev 1993;17:37-43.

4. Samsom JF, de Groot L, Bezemer PD, et al. Muscle power development during the first year of life predicts neuromotor behaviour at 7 years in preterm born high-risk infants. Early Hum Dev 2002;68:103-118.