Study On The Development Of Visual Perception In Preterm Infants And Its Early Intervention In Community

Neurodevelopmental outcomes associated with preterm are of major health and educational concern. Preterm infants are at greater risk for neurodevelopmental disabilities than full term infants. There is substantial evidence that very preterm/VLBW have negative consequences on cognitive, motor and sensory functioning and therefore, regular and long-term follow-up is important in preterm infants. The aims of this study were to describe the longitudinal development of flash visual evoked potentials (FVEPs) in individual preterm infants from1to36months and to detect the developmental trajectories of the visual electrophysiology and cognitive function between the preterm and the full-term infants. We have implemented the visual perception intervention program for preterm infants, and promoted it to community. The goal is to create a family-centered, community-based and three-tiered Maternal and Child Health network system supported El model for preterm children.Part ILongitudinal study on flash visual evoked potentials in preterm infants from18to36months[Objective]On the basis of our former studies, to follow-up and record the development of flash visual evoked potentials (FVEPs) in preterm infants at18-36months of corrected age.[Method]The children were recruited from a longitudinal follow-up study in Children’s Hospital of Fudan University, and data were gathered in the cohort of20very low birth weight (VLBW) preterm infants,27low birth weight (LBW) preterm infants and41full term(FT) infants born during2009. The FVEP recordings were carried out with the VikingQuest-IV neuroelectrophysiological device (VikingQuest, Nicolet, WI). All the subjects underwent FVEPs recordings at18、24and36months of corrected age. Two FVEP measure values were analyzed:the P2amplitude (peak to peak from the preceding N2wave) and the latency of the P2wave.[Results]1) The developmental trajectories of FVEP were similar among the three groups. The latency of the P2wave showed a more rapid decrease during the first year of life, especially within the6months of age, and a steady reduction from12to36months of age. The FVEP amplitude had no correlation with age in the three groups.2) The maturation of P2latency in LBW group is similar to that of the full term group at6months of corrected age, but the maturation of P2latency in VLBW group remained delayed when compared with the full term group until36months of corrected age. The P2latencies were prolonged significantly in the VLBW group from1and24months of corrected age compared with the full term group and showed a delay in the LBW at1and3months of corrected age.[Conclusions]1) The reaction in response to flash stimulation was delayed in premature infants, especially in VLBW infants..2) There were a rapid process and a gradual development period of visual electrophysiology maturation. The catch-up phase in visual electrophysiologic development may imply that premature infants strive to achieve visual normal evolution at their early age.3) Premature and low birth weight have the negative influence on the development of the visual system, especially for VLBW infants. Studies are needed on providing early visual interventions for preterm infants. Part ⅡLongitudinal study on early neurodevelopment in preterm infants[Objective]To explore the premature effect on the mental、motor and visual cognitive development of preterm infants from12to36months of age.[Method]We performed a prospective longitudinal study of25very preterm children (VPT:<=32weeks gestation)、30moderately to late preterm children (33-36weeks gestation)and40full-term children (FT:37-41weeks gestation) born during2009. At12,18,24and36months of corrected age, children were assessed by the Bayley-Ⅱ infant Development scale, and the results were recorded as MDI (mental development index)、PDI (psychomotor development index) and the rate of visual cognitive items passed.[Results]1) The very preterm infants showed the mean MDI were significantly lower compared with FT group at12,24and36corrected months of age(P<0.01), and the mean PDI were significantly lower than FT group at12,18,24and36corrected months of age(P<0.01).2) The mean MDI in the moderately to late preterm children was showed significantly lower than that in FT groups at24corrected months of age(P<0.01), and the same results for the mean PDI at36corrected months of age(P<0.01).3) There were significant differences on visual cognitive function in three groups of children. The percentage of passed visual cognitive items in the very preterm infants、the moderately to late preterm infants and the controls were46.3%,、61.5%and74.4%respectively.[Conclusion]Premature has the negative influence on the developmental outcomes of children’s cognitive, motor and visual cognitive function, especially for very preterm children. Findings highly suggest it is necessary to intensify follow-up for the preterm children and provide early intervention if possible. Part ⅢThe promotion of early visual perception intervention for preterm children in community[Objective]The aim of this study was to evaluate the effect of early visual perception interventions and to extend this program to more communities.[Methods]We recruited118preterm infants born between30and36completed weeks of gestation from the Min hang、Xu hui and Pu dong three districts in Shanghai during Jan1,2012-May31,2012. The preterm infants received the early visual perception interventions in their communities each month, and underwent FVEPs and BSID-II in Children’s Hospital of Fudan University at the corrected6-month-old. Meanwhile, the effects of EI、follow-up rate and degree of parent acceptance were evaluated.[Results]1) The mean P2latency was132±17ms for the intervention group, reduced by6.4%compared with the preterm control group(141±19ms), and was close to the mean of the FT controls(130±7ms).2) The dropout rate was significantly reduced compared with the previous study (21.2%vs39.4%), parent satisfaction rate was93%.[Conclusion]1) The preterm infants can benefit from the El programs, which can accelerate the maturation of visual system in the preterm children. This underscores the need for professional assessment and intervention of visual perception for the majority of preterm children.2) The health education lectures should be opened for preterm parents in the community, to raise parents’ awareness of the importance of El. We sliould provide preterm infants with effective and practical interventions to meet the needs of the parents, thus the dropout rate will be better controlled.