Development and emotional health in young children

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Recruitment

Six hundred and fourteen neonates were recruited to the neonatal studies, BABIES and Sugar Babies (2 were recruited to both studies), most of whom lived in the Waikato region at the time of enrolment (Figure 4.1.1, A).
At 2 years, 528 children were eligible for follow-up (86% of the neonatal cohort), of whom 405 (77% of those eligible) were recruited and 404 were assessed (one child died after recruitment). Of 86 children not eligible for follow-up, two died, 65 were older than 2 years when follow-up started and 19 were born <35 weeks’ gestation. Of 123 children not recruited to 2 year follow-up, 79 families declined (64% of not recruited, 13% of neonatal cohort), contact was lost with 11 children (9% of not recruited, 2% of neonatal cohort) and 33 children were overseas (27% of not recruited, 5% of neonatal cohort). Of those recruited to the 2 year follow-up study, 18% had moved from the Waikato region to the lower North Island or South Island (Figure 4.1.1, B).
At 4.5 years, 604 children were eligible for follow-up (98% of the neonatal cohort), of whom 477 (79% of those eligible) were recruited and assessed. Of the ten children who were not eligible for follow-up, three children died and seven withdrew from the study prior to 4.5 year recruitment. Of 127 children not recruited at 4.5 years (21% of eligible, 21% of neonatal cohort), 92 families declined follow-up (72% of not recruited, 15% of neonatal cohort), eight children were lost to follow-up (6% of not recruited, 1% of neonatal cohort) and 27 children were living overseas (21% of not recruited, 4% of neonatal cohort). By 4.5 years more families (24%) had moved out of the Waikato region to live in Auckland, Eastern and central regions of the North Island and also the South Island. Fourteen children were assessed in Australia at 4.5 years (Figure 4.1.1, C).

Baseline characteristics of participants and non-participants

There were no significant differences between children who were and were not eligible for 2 year follow-up in sex, ethnicity and New Zealand deprivation index (Table 4.2.1). Children eligible for 2 year follow-up were more likely to be IDM or large compared to those not eligible. Further, eligible children had higher mean gestational age and birth weight compared to those not eligible, and were less likely to have experienced neonatal hypoglycaemia. Of children eligible for 2 year follow-up, those who were assessed were similar to those not assessed except that those assessed were less likely to be Asian.
There were no significant differences between children who were eligible and not eligible for 4.5 year follow-up. Of children eligible for 4.5 year follow-up, those who were assessed were more likely to be Maori and to live in less deprived areas than those not assessed (Table 4.2.2).

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Characteristics of the 4.5 year CHYLD cohort

At 4.5 years 477 children were assessed at a mean (SD) corrected age of 54 (1.8) months. Of these 477 children, 276 (58%) became hypoglycaemic (Table 3.2). Mean (SD) BMI at 4.5 years for the entire cohort was 16.2 (1.7) kg/m2 [Z score 0.6 (1.1)]. Using recommended WHO BMI cut-offs (De Onis, 2010) 3 (1%) children were underweight, 44 (10%) children were overweight and 12 (3%) were obese (Table 4.4). Almost a fifth of the cohort were at least one SD below the test mean for cognitive function and also for language, almost a quarter for processing speed, and a quarter of the cohort were at risk of motor difficulty (≤15th centile on MABC-2, Table 4.4).

Chapter 1. Literature review.
1.1 Fetal metabolism
1.1.1 Changes in maternal metabolism during pregnancy .
1.1.2 Fetal energy requirements
1.1.3 Nutrient transport across the placenta
1.1.4 Glucose transporters
1.1.5 Changed environment: adaptations of the placenta .
1.1.5.1 IUGR
1.1.5.2 Overgrowth
1.1.6 Fetal hormone secretion
1.2 Metabolic changes at birth .
1.2.1 Glycogen and fat stores: fetal to neonatal lif
1.2.2 Insulin secretion and function in the neonate
1.2.3 Neonatal gluconeogenesis .
1.3 Definition of neonatal hypoglycaemia
1.4 Detection of hypoglycaemia
1.5 Management of neonatal hypoglycaemia
1.6 Neurodevelopmental outcomes
1.7 Development and emotional health in young children
1.8 Motor difficulties in children
Chapter 2. Introduction to the studies.
2.1 Aim of the thesis
Chapter 3. Methods and Materials.
3.1 Introduction .
3.2 Neonatal studies
3.3 Ethical approval
3.4 Recruitment and structure of follow-up studies
3.5 CHYLD two year follow-up
3.6 Follow-up at 4.5 years
3.7 Data analysis
Chapter 4. The CHYLD study cohort description.
4.1 Recruitment
4.2 Baseline characteristics of participants and non-participants
4.3 Characteristics of the 2 year CHYLD cohort .
4.4 Characteristics of the 4.5 year CHYLD cohort
4.5 Discussion
4.5.1 Neonatal and socio-demographic characteristics of the CHYLD study cohort .
4.5.2 Challenges of follow-up assessments
4.6 Summary .
Chapter 5. Growth and motor performance. .
Chapter 6. Accuracy of caregivers’ recall of hospital admissions: implications for research.
Chapter 7. Preschool screening for developmental and emotional health: comparison with neurodevelopmental assessment.
Chapter 8. Bayley-III motor scale and neurological examination at two years do not predict motor skills at 4.5 years.
Chapter 9. Factors influencing glycaemic stability after neonatal hypoglycaemia and relationship to neurodevelopmental outcome.
Chapter 10. Discussion.
11. References