Alterations in brain structure and neurodevelopmental outcome in preterm infants hospitalized in different neonatal intensive care unit environments. Neonatal head ultrasound abnormalities in preterm infants and adolescent psychiatric disorders. Abnormal sensory reactivity in preterm infants during the first year correlates with adverse neurodevelopmental outcomes at 2 years of age Long-term impact of neonatal intensive care and surgery on somatosensory perception in children born extremely preterm Early experience alters brain function and structure. Influence of perinatal, developmental and environmental factors on cognitive abilities of preterm children without major impairments at 5 years. Patterned feeding experience for preterm infants: study protocol for a randomized controlled trial Developmental intervention for preterm infants diagnosed with periventricular leukomalacia. Neurodevelopmental and growth impairment among extremely low-birth-weight infants with neonatal infection. Neonatal pain, parenting stress and interaction, in relation to cognitive and motor development at 8 and 18months in preterm infants One-Year Outcome of Auditory-Tactile-Visual-Vestibular Intervention in the Neonatal Intensive Care Unit: Effects of Severe Prematurity and Central Nervous System Injury Patterns of visual impairment associated with lesions of the preterm infant brain. Early Sensitivity Training for Parents of Preterm Infants: Impact on the Developing Brain Neurodevelopmental outcomes following late and moderate prematurity: a population-based cohort study Brain structure and neurocognitive and behavioural function in adolescents who were born very preterm Individualized developmental care for the very low-birth-weight preterm infant. Medical and neurofunctional effects. Diagnostic and Predictive Value of Auditory Evoked Responses in Preterm Infants: II. Auditory Evoked Responses
OBJECTIVE To evaluate associations between neonatal intensive care unit ( NICU ) room type ( open ward and private room ) and medical outcomes ; neurobehavior , electrophysiology , and brain structure at hospital discharge ; and developmental outcomes at 2 years of age . STUDY DESIGN In this prospect i ve longitudinal cohort study , we enrolled 136 preterm infants born < 30 weeks gestation from an urban , 75-bed level III NICU from 2007 - 2010 . Upon admission , each participant was assigned to a bedspace in an open ward or private room within the same hospital , based on space and staffing availability , where they remained for the duration of hospitalization . The primary outcome was developmental performance at 2 years of age ( n = 86 infants returned for testing , which was 83 % of survivors ) measured using the Bayley Scales of Infant and Toddler Development , 3rd Edition . Secondary outcomes were : ( 1 ) medical factors throughout the hospitalization ; ( 2 ) neurobehavior ; and ( 3 ) cerebral injury and maturation ( determined by magnetic resonance imaging and electroencephalography ) . RESULTS At term equivalent age , infants in private rooms were characterized by a diminution of normal hemispheric asymmetry and a trend toward having lower amplitude integrated electroencephalography cerebral maturation scores ( P = .02 ; β = -0.52 [ CI -0.95 , -0.10 ] ) . At age 2 years , infants from private rooms had lower language scores ( P = .006 ; β = -8.3 [ CI -14.2 , -2.4 ] ) and a trend toward lower motor scores ( P = .02 ; β = -6.3 [ CI -11.7 , -0.99 ] ) , which persisted after adjustment for potential confounders . CONCLUSION These findings raise concerns that highlight the need for further research into the potential adverse effects of different amounts of sensory exposure in the NICU environment CONTEXT Infants born prematurely are at risk for a perinatal encephalopathy characterized by white and gray matter injuries that affect subsequent cortical development and neural connectivity and potentially increase risk for later psychiatric disorder . OBJECTIVE To determine the relation of perinatal brain injury , as detected by neonatal head ultrasound , to psychiatric disorders in adolescents who were born prematurely . DESIGN Prospect i ve cohort . SETTING Community . PARTICIPANTS Adolescent survivors of a population -based low-birth-weight ( < 2000 g ; 96 % preterm ; born 1984 - 1987 ) cohort ( n = 1105 ) screened as neonates with serial head ultrasounds .  Neonatal head ultrasound abnormalities were categorized as either ( 1 ) germinal matrix and /or intraventricular hemorrhage or ( 2 ) parenchymal lesions and /or ventricular enlargement . Of 862 eligible survivors , 628 ( 72.9 % ) were assessed at age 16 years . The sample consisted of 458 nondisabled survivors assessed in person . Main Outcome Measure Adolescent current and lifetime psychiatric disorders assessed with parent report on the Diagnostic Interview Schedule for Children-IV . RESULTS Compared with no abnormality , germinal matrix/intraventricular hemorrhage increased risk for current major depressive disorder ( odds ratio , 2.7 ; 95 % confidence interval , 1.0 - 6.8 ) and obsessive-compulsive disorder ( 9.5 ; 3.0 - 30.1 ) . Parenchymal lesions/ventricular enlargement increased risk for current attention-deficit/hyperactivity disorder-inattentive type ( odds ratio , 7.6 ; 95 % confidence interval , 2.0 - 26.5 ) , tic disorders ( 8.4 ; 2.4 - 29.6 ) , and obsessive-compulsive disorder ( 7.6 ; 1.39 - 42.0 ) . Parenchymal lesions/ventricular enlargement were not related to lifetime attention-deficit/hyperactivity disorder-inattentive type , but all other relations were similar for lifetime disorders . Control for other early risk factors did not alter these relations . Most of these relations persisted with control for concurrent cognitive or motor problems . CONCLUSION In preterm infants , 2 distinct types of perinatal brain injury detectable with neonatal head ultrasound selectively increase risk in adolescence for psychiatric disorders in which dysfunction of subcortical-cortical circuits has been implicated Background Sensory experience is the basis for learning in infancy . In older children , abnormal sensory reactivity is associated with behavioural and developmental disorders . We hypothesised that in preterm infants , abnormal sensory reactivity during infancy would be associated with perinatal characteristics and correlate with 2-year neurodevelopmental outcomes . Methods We conducted a prospect i ve observational study of infants with birth weight ≤1500 g using the Test of Sensory Function in Infants ( TSFI ) in the first year . Infants with gestational age ≤30 weeks were tested with the  Bayley Scales of Infant and Toddler Development III ( BSID III ) at 24 months . Results Of the 72 participants evaluated at 4–12 months corrected age ( median 8 months ) , 59 ( 82 % ) had a least one TSFI score concerning for abnormal sensory reactivity . Lower gestational age was associated with abnormal reactivity to deep pressure and vestibular stimulation ( p<0.001 ) . Poor ocular-motor control predicted worse cognitive and motor scores in early childhood ( OR 16.7 ; p=0.004 ) , but was tightly correlated to the presence of severe white matter injury . Poor adaptive motor function in response to tactile stimuli predicted worse BSID III motor ( p=0.01 ) and language scores ( p=0.04 ) at 2 years , even after adjusting for confounders . Conclusions Abnormal sensory reactivity is common in preterm infants ; is associated with immaturity at birth , severe white matter injury and lower primary caregiver education ; and predicts neurodevelopmental delays . Early identification of abnormal sensory reactivity of very preterm infants may promote parental support and education and may facilitate improved neurodevelopment Abstract Alterations in neural activity due to pain and injury in early development may produce long‐term effects on sensory processing and future responses to pain . To investigate persistent alterations in sensory perception , we performed quantitative sensory testing ( QST ) in extremely preterm ( EP ) children ( n = 43 ) recruited from the UK EPICure cohort ( born less than 26 weeks gestation in 1995 ) and in age and sex matched term‐born controls ( TC ; n = 44 ) . EP children had a generalized decreased sensitivity to all thermal modalities , but no difference in mechanical sensitivity at the thenar eminence . EP children who also required neonatal surgery had more marked thermal hypoalgesia , but did not differ from non‐surgical EP children in the measures of neonatal brain injury or current cognitive ability . Adjacent to neonatal thoracotomy scars there was a localized decrease in both thermal and mechanical sensitivity that differed from EP children with scars relating to less invasive procedural interventions or from those without scars . No relationship was found between sensory perception thresholds and current pain experience or pain coping styles in EP or TC children . Neonatal care and surgery in EP children are associated with persistent modality‐specific changes in sensory processing . Decreases in mechanical and thermal sensitivity adjacent to scars may be related to localized tissue injury , whereas generalized decreases in thermal sensitivity but not in mechanical sensitivity suggest central ly mediated alterations in the modulation of C‐fibre nociceptor pathways , which may impact on responses to future pain or surgery OBJECTIVE To investigate the effects of early experience on brain function and structure . METHODS A r and omized clinical trial tested the neurodevelopmental effectiveness of the Newborn Individualized Developmental Care and Assessment Program ( NIDCAP ) .  Thirty preterm infants , 28 to 33 weeks ' gestational age ( GA ) at birth and free of known developmental risk factors , participated in the trial . NIDCAP was initiated within 72 hours of intensive care unit admission and continued to the age of 2 weeks , corrected for prematurity . Control ( 14 ) and experimental ( 16 ) infants were assessed at 2 weeks ' and 9 months ' corrected age on health status , growth , and neurobehavior , and at 2 weeks ' corrected age additionally on electroencephalogram spectral coherence , magnetic resonance diffusion tensor imaging , and measurements of transverse relaxation time . RESULTS The groups were medically and demographically comparable before as well as after the treatment . However , the experimental group showed significantly better neurobehavioral functioning , increased coherence between frontal and a broad spectrum of mainly occipital brain regions , and higher relative anisotropy in left internal capsule , with a trend for right internal capsule and frontal white matter . Transverse relaxation time showed no difference . Behavioral function was improved also at 9 months ' corrected age . The relationship among the 3 neurodevelopmental domains was significant . The results indicated consistently better function and more mature fiber structure for experimental infants compared with their controls . CONCLUSIONS This is the first in vivo evidence of enhanced brain function and structure due to the NIDCAP . The study demonstrates that quality of experience before term may influence brain development significantly The relative role of perinatal factors ( birthweight , gestational age , gender , asphyxia , mechanical ventilation and cerebral lesions ) , developmental factors ( neuromotor development during the first 18 months of life ) and environmental factors ( socio-economic status and bilingualism ) on cognitive abilities was evaluated in a cohort of preterm children who had been prospect ively examined for haemorrhage ( PVH ) and periventricular leucomalacia ( PVL ) and followed-up to 5 years of age . St and ardized neurological examinations and development assessment including tests of cognitive function were carried out . Major impairments could be ascribed to the presence of large PVL changes . Among the 226 children without major impairment , the overall incidence of neuropsychological anomalies ( neuromotor , language , visual , auditory and behaviour anomalies ) was 46.5 % and did not differ within ultrasound groups ( normal scans , PVH and small PVL ) . However , children with small changes of PVL presented more abnormal neuromotor development within the first 18 months of life and had more complex neuropsychological anomalies at 5 years . The multiple regression analysis ( General Intellectual Index ( GII ) predicted = 113.7 - coefficient x social class - 8.5 x bilingualism - 5.5 x dystonia + 1.4 x gestational age + 8 x mechanical ventilation ) showed that socioeconomic status was the most important factor affecting the General Intellectual Index ( GII ) . The contribution of sex and cerebral lesions was not significant . As children grew-up , environmental factors seemed to overcome perinatal factors Background Neurobehavioral disabilities occur in 5–15 % of preterm infants with an estimated 50–70 % of very low birth weight preterm infants experiencing later dysfunction , including cognitive , behavioral , and social delays that often persist into adulthood . Factors implicated in poor neurobehavioral and developmental outcomes are hospitalization in the neonatal intensive care unit ( NICU ) and inconsistent caregiving patterns . Although much underlying brain damage occurs in utero or shortly after birth , neuroprotective strategies can stop lesions from progressing , particularly when these strategies are used during the most sensitive periods of neural plasticity occurring months before term age . The purpose of this r and omized trial is to test the effect of a patterned feeding experience on preterm infants ’ neurobehavioral organization and development , cognitive function , and clinical outcomes . Methods This trial uses an experimental , longitudinal , 2-group design with 120 preterm infants . Infants are enrolled within the first week of life and r and omized to an experimental group receiving a patterned feeding experience from the first gavage feeding through discharge or to a control group receiving usual feeding care experience . The intervention involves a continuity of tactile experiences associated with feeding to train and build neuronal networks supportive of normal infant feeding experience . Primary outcomes are neurobehavioral organization as measured by Neurobehavioral Assessment of the Preterm Infant at 3 time points : the transition to oral feedings , NICU discharge , and 2 months corrected age . Secondary aims are cognitive function measured using the Bayley Scales of Infant and Toddler Development , Third Edition at 6 months corrected age , neurobehavioral development ( sucking organization , feeding performance , and heart rate variability ) , and clinical outcomes ( length of NICU stay and time to full oral feeding ) . The potential effects of demographic and biobehavioral factors ( perinatal events and conditions of maternal or fetal/newborn origin and immunologic and genetic biomarkers ) on the outcome variables will also be considered . Discussion Theoretically , the intervention provided at a critical time in neurologic system development and associated with a recurring event ( feeding ) should enhance neural connections that may be important for later development , particularly language and other cognitive and neurobehavioral organization skills . Trial registration NCT01577615 11 April 2012 Preterm infants with periventricular leukomalacia ( PVL ) were evaluated to determine whether multi-sensory stimulation is safe and to assess whether it improved neurobehavior and neurodevelopment .  Thirty preterm infants with documented PVL were r and omly assigned to control ( n= 15 ) or experimental ( Group E ) ( n= 15 ) groups at 33 weeks post-conceptional age . Group E infants received 15 minutes of auditory , tactile , visual , and vestibular ( ATVV ) intervention twice a day , five days a week , for four weeks during hospitalization . Repeated measures ANOVA demonstrated that Group E infants experienced significant increases in heart and respiratory rate and a 0.72 % drop in hemoglobin saturation , coinciding with a significant behavioral state shift from sleep to alertness during intervention . No differences were identified in neurobehavioral function and neurodevelopment , indicating that Group E suffered no injury . Group E had an average hospital stay nine days shorter than that of controls , with the associated cost savings of $ 213,840 . The earlier hospital discharge indicates that ATVV intervention promotes alertness without compromising physiologic status in vulnerable infants CONTEXT Neonatal infections are frequent complications of extremely low-birth-weight ( ELBW ) infants receiving intensive care . OBJECTIVE To determine if neonatal infections in ELBW infants are associated with increased risks of adverse neurodevelopmental and growth sequelae in early childhood . DESIGN , SETTING , AND PARTICIPANTS Infants weighing 401 to 1000 g at birth ( born in 1993 - 2001 ) were enrolled in a prospect ively collected very low-birth-weight registry at academic medical centers participating in the National Institute of Child Health and Human Development Neonatal Research Network .  Neurodevelopmental and growth outcomes were assessed at a comprehensive follow-up visit at 18 to 22 months of corrected gestational age and compared by infection group . Eighty percent of survivors completed the follow-up visit and 6093 infants were studied . Registry data were used to classify infants by type of infection : uninfected ( n = 2161 ) , clinical infection alone ( n = 1538 ) , sepsis ( n = 1922 ) , sepsis and necrotizing enterocolitis ( n = 279 ) , or meningitis with or without sepsis ( n = 193 ) . MAIN OUTCOME MEASURES Cognitive and neuromotor development , neurologic status , vision and hearing , and growth ( weight , length , and head circumference ) were assessed at follow-up . RESULTS The majority of ELBW survivors ( 65 % ) had at least 1 infection during their hospitalization after birth . Compared with uninfected infants , those in each of the 4 infection groups were significantly more likely to have adverse neurodevelopmental outcomes at follow-up , including cerebral palsy ( range of significant odds ratios [ ORs ] , 1.4 - 1.7 ) , low Bayley Scales of Infant Development II scores on the mental development index ( ORs , 1.3 - 1.6 ) and psychomotor development index ( ORs , 1.5 - 2.4 ) , and vision impairment ( ORs , 1.3 - 2.2 ) . Infection in the neonatal period was also associated with impaired head growth , a known predictor of poor neurodevelopmental outcome . CONCLUSIONS This large cohort study suggests that neonatal infections among ELBW infants are associated with poor neurodevelopmental and growth outcomes in early childhood . Additional studies are needed to eluci date the pathogenesis of brain injury in infants with infection so that novel interventions to improve these outcomes can be explored ABSTRACT Procedural pain in the neonatal intensive care unit triggers a cascade of physiological , behavioral and hormonal disruptions which may contribute to altered neurodevelopment in infants born very preterm , who undergo prolonged hospitalization at a time of physiological immaturity and rapid brain development . The aim of this study was to examine relationships between cumulative procedural pain ( number of skin‐breaking procedures from birth to term , adjusted for early illness severity and overall intravenous morphine exposure ) , and later cognitive , motor abilities and behavior in very preterm infants at 8 and 18 months corrected chronological age ( CCA ) , and further , to evaluate the extent to which parenting factors modulate these relationships over time . Participants were N = 211 infants ( n = 137 born preterm ⩽32 weeks gestational age [ GA ] and n = 74 full‐term controls ) followed prospect ively since birth . Infants with significant neonatal brain injury ( periventricular leucomalacia , grade 3 or 4 intraventricular hemorrhage ) and /or major sensori‐neural impairments , were excluded .  Poorer cognition and motor function were associated with higher number of skin‐breaking procedures , independent of early illness severity , overall intravenous morphine , and exposure to postnatal steroids . The number of skin‐breaking procedures as a marker of neonatal pain was closely related to days on mechanical ventilation . In general , greater overall exposure to intravenous morphine was associated with poorer motor development at 8 months , but not at 18 months CCA , however , specific protocol s for morphine administration were not evaluated . Lower parenting stress modulated effects of neonatal pain , only on cognitive outcome at 18 months Thirty-seven infants with severe central nervous system injury or extreme prematurity were r and omly assigned to a multisensory ( auditory-tactile-visual-vestibular ) intervention or control group . Intervention began in the hospital at 33 weeks ' postconceptional age and continued twice daily in the home until 2 months ' corrected age . Mother-infant interactions during feedings were videotaped , and the Bayley Scales of Infant Development were administered . Control mothers stimulated their infants more during feeding , but these significant differences dissipated by 4 months . The presence of periventricular leukomalacia was associated with significantly poorer mental development , regardless of group assignment . Experimental infants tended to exhibit better motor and mental performance and had 23 % fewer cerebral palsy diagnoses at 1 year , but these trends were not statistically significant . The type of brain injury was more important in determining 1-year developmental outcome than type of postnatal experience , suggesting that periventricular leukomalacia presents a major challenge for infant development . ( J Child Neurol 2001;16:493 - 498 ) The visual function of 42 children with haemorrhagic and /or ischaemic cerebral lesions acquired before a gestational age of 35 weeks was examined and related to cranial ultrasound in the neonatal period and to MRI and neurodevelopmental status at follow-up . All 37 children with abnormal ultrasound scans and one of the five with normal ultrasound scans showed impairment of one or more aspects of visual function . While impaired acuity was more frequent among infants with MRI evidence of visual pathway damage , this was not an invariable finding . Normal or near-normal visual acuity did not preclude the presence of other functional visual deficits . The authors conclude that preterm cerebral insults may produce a variety of visual difficulties , the pattern and severity of which can not be predicted on imaging . Each child therefore requires individual assessment of multiple aspects of visual function After birth , preterm infants face a stressful environment , which may negatively impact early brain development and subsequent neurobehavioral outcomes . This r and omized controlled trial involving 45 women with infants < 30-wk gestation , assessed the effectiveness of training parents  in reducing stressful experiences . Intervention consisted of 10 sessions in the Neonatal Intensive Care Unit ( NICU ) . Postintervention , at term-equivalent ( 40-wk postmenstrual age ) , magnetic resonance imaging ( MRI ) was performed to evaluate brain structure and development . Quantitative volumetric techniques were used to estimate overall and regional brain volumes for different tissue types including CSF , CGM , DNGM , UWM , and MWM . DTI was used to evaluate the integrity and maturation of white matter by ADC and FA . Maturation and connectivity of white matter , characterized by diffusion MR measures of ADC and FA , were significantly enhanced in the intervention group , who displayed greater restriction in ADC and increase in FA . There were no significant effects on either brain volumes or on short-term medical outcomes . Thus , sensitivity training for parents in the NICU is associated with improved cerebral white matter micro-structural development in preterm infants Objective There is a paucity of data relating to neurodevelopmental outcomes in infants born late and moderately preterm ( LMPT ; 32 + 0–36 + 6 weeks ) . This paper present the results of a prospect i ve , population -based study of 2-year outcomes following LMPT birth . Design 1130 LMPT and 1255 term-born children were recruited at birth . At 2 years corrected age , parents completed a question naire to assess neurosensory ( vision , hearing , motor ) impairments  and the Parent Report of Children 's Abilities-Revised to identify cognitive impairment . Relative risks for adverse outcomes were adjusted for sex , socio-economic status and small for gestational age , and weighted to account for over-sampling of term-born multiples . Risk factors for cognitive impairment were explored using multivariable analyses . Results Parents of 638 ( 57 % ) LMPT infants and 765 ( 62 % ) controls completed question naires . Among LMPT infants , 1.6 % had neurosensory impairment compared with 0.3 % of controls ( RR 4.89 , 95 % CI 1.07 to 22.25 ) . Cognitive impairments were the most common adverse outcome : LMPT 6.3 % ; controls 2.4 % ( RR 2.09 , 95 % CI 1.19 to 3.64 ) . LMPT infants were at twice the risk for neurodevelopmental disability ( RR 2.19 , 95 % CI 1.27 to 3.75 ) . Independent risk factors for cognitive impairment in LMPT infants were male sex , socio-economic disadvantage , non-white ethnicity , preeclampsia and not receiving breast milk at discharge . Conclusions Compared with term-born peers , LMPT infants are at double the risk for neurodevelopmental disability at 2 years of age , with the majority of impairments observed in the cognitive domain . Male sex , socio-economic disadvantage and preeclampsia are independent predictors of low cognitive scores following LMPT birth BACKGROUND Infants born very preterm ( <33 weeks ) are at increased risk of neurocognitive deficits . Their neurodevelopmental outcome up to age 8 years can be predicted by neonatal ultrasonography , but little is known of their later function . We investigated the effect of very preterm birth on brain structure and neurocognitive and behavioural functioning in adolescence . METHODS A cohort of 105 infants born before 33 weeks of gestation in 1979 - 80 had ultrasonographic scans at University College Hospital , London , and were prospect ively examined at 1 , 4 , and 8 years . At age 14 - 15 years , 72 of those who remained in UK ( cases ) and 21 age-matched full-term controls underwent brain magnetic resonance imaging ( MRI ) , as well as neurological , cognitive , and behavioural assessment . MRI images were assessed by two neuroradiologists unaware of ultrasonographic findings or case or control status . FINDINGS Of the 72 cases , 40 had unequivocally abnormal MRI and 15 had equivocal scans . Of the 21 controls , one had abnormal and five equivocal MRI . Abnormalities of ventricles , corpus callosum , and white matter were especially common in cases . More brain lesions were identified by MRI than by neonatal ultrasonography . The cases had significantly more reading , adjustment , and neurological impairments than controls , but their behaviour was significantly related to MRI abnormality . INTERPRETATION Individuals born very preterm show an excess of neurocognitive and behavioural problems in adolescence , and more than half have abnormal MRI brain scans OBJECTIVE To investigate the effectiveness of individualized developmental care in reducing medical and neurodevelopmental sequelae for very low-birth-weight infants . DESIGN R and omized controlled trial . SETTING Newborn intensive care unit . PATIENTS Thirty-eight singleton preterm infants , free of known congenital abnormalities , weighing less than 1250 g , born before 30 weeks ' gestation , mechanically ventilated within 3 hours of delivery and for more than 24 hours in the first 48 hours , r and omly assigned to a control or an experimental group . INTERVENTION Caregiving by nurses specifically trained in individualized developmental care ; observation and documentation of the infants ' behavior within 12 hours of admission , and subsequently every 10th day ; developmental care recommendations and ongoing clinical support for the nurses and parents based on regular observation of the infant by developmental specialists ; and the availability of special caregiving accessories . MAIN OUTCOME MEASURES Medical outcome , including average daily weight gain ; number of days the infant required mechanical ventilation , oxygen , gavage tube feeding , and hospitalization ; severity of retinopathy of prematurity , bronchopulmonary dysplasia , pneumothorax , and intraventricular hemorrhage ; pediatric complications ; age at discharge ; and hospital charges . Neurodevelopmental outcome , including Assessment of Preterm Infants ' Behavior scale and quantified electroencephalography ( 2 weeks after due date ) ; and Bayley Scales of Infant Development and Kangaroo Box Paradigm ( 9 months after due date ) . RESULTS The infants in the experimental group had a significantly shorter duration of mechanical ventilation and supplemental oxygen support ; earlier oral feeding ; reduced incidence of intraventricular hemorrhage , pneumothorax , and severe bronchopulmonary dysplasia ; improved daily weight gain ; shorter hospital stays ; younger ages at hospital discharge ; and reduced hospital charges compared with the infants in the control group . At 2 weeks after their due date s , these infants also showed improved autonomic regulation , motor system functioning , self-regulatory abilities , and visual evoked potential measures ; and at 9 months , they had improved Bayley Mental and Psychomotor Developmental Index scores , as well as Kangaroo Box Paradigm scores . CONCLUSION Very low-birth-weight preterm infants may benefit from individualized developmental care in the neonatal intensive care unit in terms of medical and neurodevelopmental outcome In this study , the diagnostic and predictive value of brainstem , middle latency , and cortical auditory evoked responses ( BMC -AERs ) obtained in the neonatal period in 81 preterm infants was assessed in relation to neurodevelopmental outcome .  The preterm infants were neonatally classified according to risk category and gestational age . The  BMC -AERs  were analyzed with respect to detectability , latencies , and amplitudes as well as derived latency and amplitude measures . At 5 y of age the neurodevelopmental outcome was assessed from neurologic and neuropsychologic evaluations . The results showed that BMC -AER differences mainly correlated with risk category ( low risk/high risk ) and to some extent with degree of prematurity . In view of these findings the degree of prematurity and the effect of risk category have to be taken into account , when BMC -AERs are applied in the preterm period to predict neurodevelopmental outcome . In this study the BMC -AERs for infants with abnormal neurodevelopmental outcome were scarcely distinguishable from the BMC -AERs for infants with normal neurodevelopmental outcome . Thus far , this and previous reports have indicated that BMC -AERs in preterm infants are useful in maturational studies and with infants showing symptoms related to lesions or dysfunction of the peripheral and /or central auditory system . For predicting neurodevelopmental outcome in preterm infants , BMC -AERs are of limited clinical value
Results of this review support the presence of sensory modulation problems in preterm children .
Sensory modulation problems may play a key role in underst and ing neurocognitive and behavioral sequelae in preterm children .
Some support is found for a dose-response relationship between both white matter brain injury and length of NICU stay and sensory modulation problems
BACKGROUND Neurodevelopmental sequelae in preterm born children are generally considered to result from cerebral white matter damage and noxious effects of environmental factors in the neonatal intensive care unit ( NICU ) .
Cerebral white matter damage is associated with sensory processing problems in terms of registration , integration and modulation .
However , research into sensory processing problems and , in particular , sensory modulation problems , is scarce in preterm children .
AIM This review aims to integrate available evidence on sensory modulation problems in preterm infants and children ( < 37 weeks of gestation ) and their association with neurocognitive and behavioral problems .