ETD Collection

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    The reliability of the Molteno Adapted Development Scale in predicting developmental outcomes at 2 years, in prematurely born very low birth weight infants
    (2011-04-07) Laughton, Barbara
    Background: Prematurely born very low birth weight (VLBW) infants are at high risk for neurodevelopmental problems and require regular follow up. Within the South African context, one needs a reliable and user-friendly screening tool to identify those who require intervention. The Molteno Adapted Scale (MAS) is used for this purpose in many clinics, but it has never been validated. Aim: To assess if the MAS performed on young prematurely born infants reliably predicts the neurodevelopmental outcome at 2 years of age as determined by the Griffiths Mental Development Scales (GMDS). Methods: A retrospective study of records of VLBW infants between 1998 and 2006, from the Panorama Medi-Clinic Neonatal Intensive Care Unit follow up clinic. Infants with birth weights < 1500g and accurately assessed gestation < 34 weeks were included. Those who suffered brain insults e.g. meningitis, between the early assessments and the GMDS were excluded. For each child, quotients obtained from the MAS at early assessments were compared to quotients obtained on the GMDS after 2 years of age using Spearman correlations. Results: Fifty-two (27 boys) VLBW infants were included in the study, with a mean birth weight of 981.2 ± 225.5 g and mean gestation of 27.7 ± 1.9 weeks. Thirteen (25%) infants had cerebral palsy and two had visual impairment. MAS assessments were performed at mean ages of 5.1, 10.1 and 16.8 months and the GMDS at a mean age of 28.8 months. Correlations between the MAS and the GMDS ranged from 0.1 - 0.43 at the first assessment, 0.29 - 0.46 at the second assessment and 0.52 - 0.63 at the third assessment. Correlations were statistically significant for the Fine Motor quotient on the MAS at the first assessment, the General quotient and Personal Social quotient at the second assessment, and all quotients except Personal Social at the third assessment. Conclusion: Developmental quotients on the MAS at 5.1 and 10.1 months have a weak positive correlation with the GMDS at 28 months. The MAS at 16.8 months significantly correlated with the developmental outcome as assessed on the GMDS at a mean age of 28 months in prematurely born VLBW infants.
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    Growth patterns in a cohort of very low birth weight infants in Johannesburg: a retrospective review
    (2010-08-24) Mackay, Cheryl Anne
    INTRODUCTION: Improved survival of VLBW infants is raising several management issues. An example is that of growth and growth monitoring. AIM OF THE STUDY: To assess the growth of a cohort of VLBW infants born at CMJAH from term CGA to 20 months CGA. METHODS: A retrospective chart review was conducted on 139 VLBW infants (birth weight ≤ 1500g) born at CMJAH between 1 July 2006 and 28 February 2007. RESULTS: Comparison with a term growth reference showed initial growth failure followed by gradual catch up growth but with persistent deficits in length for age. Comparison with international VLBW references showed similar growth for weight and head circumference for age but with deficits in length for age. Growth parameters of the study sample were similar to those of other South African VLBW infants. CONCLUSION: Growth and growth monitoring in VLBW infants is complicated by characteristic growth patterns, high associated morbidity, controversies surrounding ideal growth and lack of an ideal growth reference. Significant deficits in length for age in the study sample may have been due to the large proportion of infants born SGA and the high prevalence of stunting in South African children. Current recommendations for growth monitoring of VLBW infants include the use of a VLBW reference up to two years CGA followed by a term growth reference thereafter