Longterm Followup of VLBW Infants: Parental Influence on the Cognitive Outcome of the Children

The survival rate of VLBW infants is increasing constantly. However, compared to their peers these children exhibit more cognitive, social and behavioral impairments which persist until school entry or beyond. In the following project we intend to investigate the influence of parental variables (personality, mother-child-interaction) on the cognitive outcome of VLBW infants A random control sample of children born at term is tested at the same time and with the same schedule. A basic requirement for this study is a sophisticated developmental evaluation of the children indicating possible deficits. Current developmental tests (Bayley II, Denver II, Griffiths Scales) will be employed. Thus these results will be used to set up an early intervention program with two main aspects (functional support tailored to the child`s particular needs, parent guidance) and the effects will be recorded in a further study. The comparison of three developmental tests (Denver II, Griffiths Scales, Bayley II) at the age of 12 and 24 months in children born prematurely and a random control sample of children born at term, should show the usefulness of internationally widely used English language tests for German-speaking areas and also indicate possible advantages of individual tests. In the following years, an analogous test comparison with developmental tests and screening procedures (Kaufman Assessment Battery for Children (K-ABC), Vienna Development Test (WET), Denver II) for 3- to 6-year-old children will be carried out and the question of possible prognostic values of developmental tests during the first five years of life for later school success will be investigated.

In agreement with the literature the results of our project show, that about a third to a quarter of VLBWI (birth weight lower than 1500 grams and gestational age lower than 32 weeks) will have lasting developmental problems. Medical factors and not the personality of their parents, their interaction with the child or their social background have significant influence on the development of these children in the first years of life. Despite important progress in Neonatology there are premature infants who show developmental deficits, which will last up to adulthood, as we know so far. Neuromotor development but also memory and attention capacities as well as visumotor integration are significantly affected. Beside a differentiated diagnostic of these impairments with developmental inventories and a comparison of their validity and sensitivity we investigated the influence of personality factors of the parents on the development of these children. We could show, that for the development in the first years of life medical factors and not the personality of the parents nor their interaction with the child are responsible. Children at risk are children with a birth weight lower than 1000 grams, with long duration in the hospital mainly due to medical complications. The personality of the parents - maternal depression and anxiety are often described as risk factors - but also their interaction with the child and their social background had no significant influence on the development of the children in their first years. As well we could not find any differences in the personality of mothers of premature babies in comparison to mothers of healthy full-term babies. Mothers of premature babies are often overcharged due to the traumatic character of a premature birth and may react in a more depressive and anxious way with their, sick or impaired, baby. Social support and accompany are therefore of immense importance. The extent of the developmental impairments or deficiencies of the children can only be partly compensated by intervention programs, especially in the first years of life. Later on children with low social background profit more by supportive interventions. A prerequisite for the establishment of a tailored support is a differentiated developmental diagnostic. We recommend standardized developmental inventories. Prognosis of the later development of intelligence due to the results of developmental test are limited to severe impairments which are obvious at the end of the first year of life.