NEONATAL AND NEURODEVELOPMENTAL SIGNIFICANCE OF BEHAVIOR IN VERY LOW-BIRTH-WEIGHT CHILDREN

A total of 73 (34%) of 213 inborn, long-term survivors with a birthweight < 1500 g showed characteristics of attention deficit disorder (ADD) during psychological testing at 2 yr of age corrected for prematurity. Agreement on the diagnosis of ADD made by the pediatrician and psychologist in separate examinations was statistically significant. Children with ADD differed from those with normal behavior on a large number of neonatal variables which werer reduced to the following 5 on stepwise discriminant function analysis: necrotizing enterocolitis, bronchopulmonary dysplasia, major apneas requiring bag and mask resuscitation, duration of feeding on i.v. fat and weight percentile at discharge. These neonatal variables correctly classified 69% of children into their actual behavior group at 2 yr. On psychological testing, children with ADD had a significantly lower mental score on the Bayley Scales of Infant Development and were found on their pediatric/neurological examination at 2 yr to have a significantly smaller head circumference, more tone disorders, poorer visual tracking and visual motor coordination, poorer gross and fine motor coordination and significantly more minor physical and neurological disabilities than normally behaved children. The behavior of very low birthweight infants during formal psychological testing at 2 yr is a potent indicator of past neonatal experience and current neurodevelopmental status.