The Hermitage Amsterdam
Information
Accreditation Accreditation is requested by the NVK and NIP.
Information Liesbeth Osterop, Communication & Public Relations Emma Children’s Hospital AMC Meibergdreef 9, Postbus 22660, 1100 DD Amsterdam Tel. + 31 20 – 566 7987 / [email protected] www.amc.nl/ekz The Dutch Neonatal Follow-Up Work Group celebrates her 20th anniversary by organising an exquisite congress on obstetric, neonatal, and long-term aspects of preterm birth.
The last 20 years have shown a decrease in perinatal mortality and neonatal mortality. This improvement has led to treatment of more immature infants with lower birth weights. Evaluating perinatal and neonatal care is therefore more and more important. Although major improvements have been made to optimize preterm children's outcomes at the long-term, preterm birth is still associated with neurodevelopmental disabilities.
In the morning, lectures to be given will point out the importance of long-term follow- up for obstetric care, the impact of neonatal care on long-term follow-up, important neurobehavioural interventions as well as the current state of the art on long-term outcomes of NICU graduates.
In the afternoon, diverse interactive workshops offer the opportunity to increase knowledge and skills on developmental and school age assessments as well as on intervention programs designed to protect the preterm infant's brain at the neonatal ward or post discharge.
Aleid van Wassenaer-Leemhuis, MD, PhD (president) Corine Koopman-Esseboom, MD, PhD Jeroen Vermeulen, MD, PhD Ria Nijhuis-van der Sanden, PPT, PhD Anneloes van Baar, PhD Nynke Weisglas-Kuperus, MD, PhD Cornelieke Aarnoudse-Moens, PhD
Programme
9.00 - 9.30 hr Registration
Chair: Arend Bos
9.30 - 9.45 hr ‘On 20 years follow up of very low birthweight infants in the Netherlands’ Aleid van Wassenaer-Leemhuis
9.45 - 10.25 hr ‘On the importance of child follow up in decision making in obstetrical care of high risk pregnancies’ Dwight Rouse
10.25 - 11.05 hr ‘How neonatal care has altered long term child outcome. Where next? ’ Neil Marlow
11.05 - 11.30 hr Coffee
11.30 - 12.10 hr ‘Important ingredients of neurobehavioural interventions; what will make a change for long-term child outcome’ Björn Westrup
12.10 - 12.35 hr ‘The Bayley III: a 'new' instrument to assess infant and toddler development in The Netherlands’ Anneloes van Baar
12.35 - 12.50 hr The European Foundation for the Care of Newborn Infants Silke Mader
12.50 - 14.15 hr Lunch with presentation e-posters and possibility to visit museum
14.15 - 15.15 hr Workshops
15.30 - 16.30 hr Workshops
16.30 - 17.30 hr Farewell drinks
Speakers
Cornelieke Aarnoudse-Moens, PhD, child neuropsychologist neonatal follow-up, Emma Children's Hospital Amsterdam AMC, The Netherlands
Anneloes van Baar, PhD, professor of Pedagogics, Faculty of Social Sciences at Utrecht University.
Arend Bos, MD, PhD, professor of Neonatology, University Medical Center Groningen, The Netherlands
Silke Mader, Chairwoman European Foundation for the Care of Newborn Infants (EFCNI)
Neil Marlow, MD, PhD, professor of Neonatology, University College, London
Jaap Oosterlaan, PhD, professor of Pediatric Neuropsychology, Department of Clinical Neuropsychology, VU University Amsterdam, Amsterdam, The Netherlands
Dwight Rouse, MD, MSPH, professor of Obstetrics and Gynaecology, Alpert Medical School of Brown University and Maternal-Fetal Medicine, Women & Infants Hospital of Rhode Island, USA
Jeroen Vermeulen, MD, PhD, associate professor of Child Neurology, VU University Medical Center, Neuroscience Campus Amsterdam, The Netherlands
Aleid van Wassenaer-Leemhuis, MD, PhD, head of neonatal follow up Emma Children’s Hospital AMC. Chair of the Dutch Neonatal Follow-up working group
Nynke Weisglas-Kuperus, PhD developmental pediatrician, Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, The Netherlands
Björn Westrup, MD, PhD, medical director of neonatology/director of the Karolinska NIDCAP Training Center, Karolinska University Hospital, Stockholm
Marie-Jeanne Wolf, Head EOP (Expertisecentrum Ontwikkelings-ondersteuning Prematuren), Amsterdam, The Netherlands Presentations
9.30 - 9.45 hr ‘On 20 years follow up of very low birthweight infants in the Netherlands’ Aleid van Wassenaer-Leemhuis
The LNF working group was an initiative of pediatricians, psychologists, speech therapist and physiotherapists from all 10 NICU’s. Today we are still working together, and input is needed from all professionals and from all sites. Over the past 20 years neonatology and long term follow up care both have improved. Also, parents have an increasingly important role. On the one hand is more known how to support them, and on the other hand they give important feedback on how to improve follow up programs. Follow up care is and should remain an integral part of each NICU.
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9.45 - 10.25 hr ‘On the importance of child follow up in decision making in obstetrical care of high risk pregnancies’ Dwight Rouse
In my talk, I will discuss why and when long term follow-up is important, when it is less important, and that it is best accomplished with prospective planning. The perspective that I will take is that of a clincal trialist, and I will acknowledge that rarely does an obstetric trial lead to robust conclusions about long term outcome.
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10.25 - 11.05 hr ‘How neonatal care has altered long term child outcome. Where next? ’ Neil Marlow
Over the past 40 years outcome has improved decade on decade and continues. Careful studies are needed to show this over short time frames. I will review evidence for improving outcomes and then review more recent interventions that may help to improve outcomes. Finally I will suggest areas where interventions may target such outcomes to improve the next generation of very preterm graduates.
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11.30 - 12.10 hr ‘Important ingredients of neurobehavioural interventions; what will make a change for long-term child outcome’ Björn Westrup
The presentation will discuss important ingredients of neurobehavioural interventions proven to change the long-term outcome of prematurely born infants as well as the implications it has on the system of neonatal care and follow-up - a systems perspective of neonatology.
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12.10 - 12.35 hr ‘The Bayley III: a 'new' instrument to assess infant and toddler development in The Netherlands’ Anneloes van Baar
This presentation will inform the audience on the progress of the study to create Dutch norms for the Bayley-III-NL. The LNF actively was involved in acquiring funds and support for this project. The information will show the adaptations needed, as well as some preliminary results.
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12.35 - 12.50 hr The European Foundation for the Care of Newborn Infants Silke Mader, Member of the Trustee board of
EFCNI is a non-profit organization and founded from parents and professionals to improve the situation on maternal and newborn health and aftercare services in Europe. In 2010 a Benchmarking Report was published to show politicians, but also other stakeholders and decision makers the need to act. One baby in ten is born premature, but a standard of care in Europe is lacking. EFCNI wants to develop and implement standard of cares in collaboration with parent organisations and professional societies. In 2011 EFCNI published and launched a White Paper on maternal and newborn health and aftercare services in the EU Parliament. It is now time to act and EFCNI is actively asking for everybody's vote on the ene mene mini website www.ene-mene-mini.eu.
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Workshops
Auditorium Workshop 1 Developmental assessment measures Anneloes van Baar
In this workshop strengths and difficulties of different measures to assess developmental outcome, such as the Ages and Stages Questionnaires and the Bayley scales, will be discussed.
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Tsjechovzaal Workshop 2 How to diagnose CP and MND Jeroen Vermeulen and Nynke Weisglas-Kuperus
Neurological disabilities are a major complication of preterm birth. We will address neuromotor development, the diagnosis of the different types of cerebral palsy and functional classification for mobility with the Gross Motor Function Classification System.
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Tolstojzaal Workshop 3 Neurobehavioural intervention in Sweden and the Netherlands Björn Westrup and Marie-Jeanne Wolf
Two neurobehavioural family support programs, based on NIDCAP in Sweden and based on IBAIP in the Netherlands, will be presented.
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Poesjkinzaal Workshop 4 Delivering a high risk fetus; how best to protect the brain Neil Marlow and Dwight Rouse
Counselling parents in the face of fetal compromise is an imprecise art; critical interventions can help to optimize the baby's chances. Options for interventions based around clinical cases in an interactive session will be discussed.
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Poesjkinzaal Workshop 5 Assessment of high risk children at school age Jaap Oosterlaan and Cornelieke Aarnoudse-Moens
Using three cases and literature review this workshop will teach in an interactive way how to best assess school, behavior and cognitive problems, at school age. Strengths and difficulties of diverse assessment measures will be discussed.
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Abstracts
I
Stepwise assessment of child development: The usability of the ASQ-3 as a screening questionnaire
L.Steenis; M. Verhoeven; A.L. van Baar.
The Bayley Scales of Infant and Toddler Development (Bayley III) is frequently used by professionals to assess early child development. However, this assessment is costly and time-consuming. An alternative might be to first ask parents about the development of their child by means of the Ages and Stages
Questionnaire (ASQ-3) and only administer the Bayley Scales to children with a worrying development based on the ASQ-3. This study investigates to what extent these two measurements concur.
291 Children participated within the age range of 1 to 43 months (M=19.87, SD=12.61; 51.4 % boys). Trained testers administered the Bayley-III-NL which measures cognitive, language, and motor development. Mothers completed the ASQ-3 which measures the development of communication, problem solving, personal-social, fine motor, and gross motor skills.
Preliminary results show that, overall, the ASQ-3 is moderately correlated with the Bayley-III-NL and has a low sensitivity and a high specificity. In addition, the ASQ-3 identifies more children at risk for a developmental delay than is confirmed by the Bayley-III-NL. However, not all children that fail on the Bayley-III-NL are also identified by the ASQ-3. These finding indicate that caution is needed when using the ASQ-3 as a screening questionnaire. Because in this study only a small number of children were identified as developmentally delayed by the Bayley-III-NL, more research is necessary in a sample consisting of more children at risk for developmental delay. II
Antenatal factors associated with developmental delay in moderately preterm-born children.
Jorien.M. Kerstjens MD; Andrea F de Winter PhD; Krystyna Sollie MD; Inger F Bocca-Tjeertes
MD; Sijmen A Reijneveld MD PhD; Arend F Bos MD PhD.
Objective: To determine the association between antenatal factors and developmental delay in early childhood in moderately preterm-born children.
Study design: Community-based cohort study. We measured development with the Ages and Stages
Questionnaire at age 43-49 months, in 834 moderate preterms born in 2002-2003. Data on antenatal
(maternal and fetal) factors were obtained from several medical sources. We used logistic regression to estimate odds ratios (ORs) for developmental delay, adjusted for socio-demographic variables.
Results: In univariate analyses, several antenatal factors were associated with risk of developmental delay. In multivariate analyses, only pre-existent maternal obesity (OR: 3.0, 95% confidence interval (CI): 1.5-5.8), small-for-gestational-age (SGA) (OR: 2.9, CI: 1.4-6.1), multiple pregnancy (OR: 1.8, CI: 1.0-3.3), and male gender (OR: 4.1, CI: 2.2-8.6) increased developmental risk.
Conclusions: Our findings warrant more focus on maternal pre-pregnancy weight, fetal weight gain during pregnancy and number of embryos in assisted reproduction in the hope to enhance developmental chances in children eventually born moderately preterm.
III
Validation of the Dutch 60 months Ages and Stages Questionnaire (ASQ)
J Hornman; JM Kerstjens; AF de Winter; AF Bos, SA Reijneveld.
Introduction The Ages and Stages Questionnaire (ASQ) is currently the most widely used parent-completed developmental screener. Psychometric properties of the Dutch ASQ 60-months version (Dutch_ASQ-60) have not yet been assessed.
Aim: To assess the psychometric properties of the Dutch_ASQ-60.
Material & methods: Parents of 426 term-born and 1111 preterm-born children from the prospective cohort study Lollipop filled in the Dutch_ASQ-60 and a general questionnaire on educational problems, when the children were 57-63 months old. Dutch cut-off values, reliability and validity (content, construct and concurrent) of the Dutch_ASQ-60 were determined for both the original ASQ score (at least 1 abnormal ASQ
Domain-score) and the ASQ-Total score. Furthermore mean domain scores of the Dutch_ASQ-60 were compared with versions in other languages.
Results: There were no problems with content validity in an expert meeting. Cronbach’s alpha, as measure for reliability was 0.86 for the ASQ-total score. Male gender, prematurity, low paternal education, low family income and small-for-gestational-age (SGA) were associated with abnormal ASQ scores, confirming construct validity. Concurrent validity at age 5 for special educational needs was good for both the original ASQ score
(sensitivity 80% and specificity 78%) and the ASQ-Total score (sensitivity 65% and specificity 94%). Area under the curve (AUC) for the ASQ-Total score was 0.86. Mean ASQ-scores for the Dutch_ASQ-60 differed only slightly from other countries: Cohen’s delta was above 0.5 for 3 out of 15 comparisons.
Conclusion: The Dutch_ASQ-60 has good psychometric properties to screen for developmental problems at age 5 years. IV
Development and Parenting in 12-Month-Old Moderately Preterm Children
De Jong M.; Verhoeven M.; Van Baar A.L.
Introduction: Every year 6-11% of children are born with a gestational age of 32-36.6 weeks (moderately preterm). Little is known about the consequences of moderately preterm birth. Differences in development and parenting in groups of moderately preterm (MPT) and full term (FT) children at 12 months of (corrected) age are investigated. In addition relations between parenting and developmental outcomes are studied.
Methods: Participants are 117 MPT (gestational age: M = 34.8 weeks, SD =1.3; birth weight: M = 2610 grams, SD = 512) and 98 FT (gestational age: M = 39.5 weeks, SD =1.0; birth weight: M = 3587 grams, SD =
451) children and their mothers. Mothers answered the Ages and Stages Questionnaire (ASQ), the Ages and
Stages Questionnaire: Social-Emotional (ASQ SE), the Comprehensive Early Childhood Parenting
Questionnaire (CECPAQ), and the Questionnaire on Stimulation of Toddlers (QST).
Results: After controlling for maternal educational level and being first child, MPT children were found to have more social-emotional problems than FT peers. No differences were found on other domains of development.
Mothers of MPT children indicated to stimulate their children more than mothers of FT children, but no differences were found for parental warmth and structuring activities. Social emotional development was associated with more parental warmth and structuring activities in both groups.
Conclusion: MPT children seem to be at higher risk for social-emotional problems. Parental warmth and structure may buffer for these social-emotional problems.
V
A neurobehavioral Intervention and Assessment Program in Very low Birth Weight Infants;
Outcome at 5 years of corrected age.
Janeline W.P. Van Hus, PT; Martine Jeukens-Visser, PhD; Karen Koldewijn, PhD; Christiaan J.A.
Geldof, MSc; Joke H. Kok, MD PhD; Aleid G. Van Wassenaer-Leemhuis, MD PhD; Frans Nollet,
MD PhD.
Background We carried out a RCT to evaluate the effect of the Infant Behavioral Assessment and
Intervention Program (IBAIP) in 176 VLBW infants. This post discharge intervention program was given until 6 months CA. Positive intervention effects were found on mental outcome at 6 and on motor outcome at 6, 24, and 44 months.
Aim To evaluate the effect of the IBAIP in VLBW infants on cognitive, neuromotor, and behavioral development at 5.5 years CA.
Methods Development was assessed using the Wechsler Preschool and Primary Scale of Intelligence
(WPPSI-III-NL), the Movement Assessment Battery for Children (MABC-2), the Developmental Test of Visual
Motor Integration (VMI), a neurological examination, and the Strength and Difficulties questionnaire (SDQ).
Results Sixty-nine VLBW children in the intervention and 67 VLBW children in the control group participated at 5.5 years CA (response rate 77.3%). Some important social and perinatal risk factors were at the disadvantage of the intervention group. Verbal and performance IQ-scores <85 occurred significantly less often in the intervention group (17.9% versus 33.3%, p = 0.041, and 7.5% versus 21.2%, p = 0.023, respectively). After adjustment, only the odds ratio for performance IQ was significant: 0.24, 95% CI: 0.06-
0.95. Significant intervention effects on mean scores were found on WPPSI-III-NL subtasks block design and vocabulary. After adjustment, mean scores were significantly better in the intervention group on these WPPSI-
III-NL subtasks, MABC-2 component aiming and catching and the VMI.
Conclusions The IBAIP leads to improvement in intelligence, ball skills and visual-motor integration at 5.5 years CA. VI Concurrent and Predictive Validity of the Test of Infant Motor Performance and Alberta
Infant Motor Scale for Independent Walking of Infants Born Preterm
Jacqueline Nuysink, PPT, MSc; Ingrid C. van Haastert, PPT, PhD; Maria J.C. Eijsermans, PPT,
BSc; Corine Koopman-Esseboom, MD, PhD; Paul J.M. Helders, PPT, PhD; Linda S. de Vries, MD,
PhD; Janjaap van der Net, PPT, PhD.
Aim: To assess concurrent and predictive validity of the Test of Infant Motor Performance (TIMP) and the
Alberta Infant Motor Scale (AIMS) for motor development and independent walking of infants born preterm
(gestational age <30 weeks).
Methods: 113 infants were examined at 3 months corrected age (CA) with both tests and around 6 and 15 months CA with the AIMS. At 3 months CA, correlations of raw-scores, Z-scores, and a cut-off score of the
TIMP for diagnostic agreement were determined. Regression was used to determine predictive validity, and survival analysis to predict age of independent walking.
Results: The correlation between TIMP and AIMS raw-scores was 0.82, and between Z-scores 0.71. A cut-off
Z-score of -1.0 on the TIMP had a diagnostic agreement of 92% (κ=0.67) with an AIMS-score AIMS-scores at 6 months CA predicted the AIMS-scores at 15 months CA, ‘early stepping’ (OR 2.6; 95%CI=1.55–4.47), and ‘walks alone’ (OR 3.2; 95%CI=1.86-5.65). The median age of independent walking was 15.7 (95%CI=15.21-16.26) months CA. No significant medical prediction factors were found. Interpretation: A prediction on gross motor development at 15 months CA and independent walking could not be given prior to 6 months CA using the AIMS. V II Complications on the Age of Independent Walking in NICU Graduates A.L. de Nooijer, I.C. van Haastert, M.J.C. Eijsermans, F. Groenendaal, J. van der Net Aim: To (I) determine the age of independent walking (AIOW) of neonatal intensive care unit (NICU) graduates, taking into account the neonatal complications infants endured; (II) to compare the outcome between preterm (PT) and full-term (FT) born infants, and with a Dutch population. Methods: This is a retrospective cross-sectional study of 1223 NICU graduates (1010 PT and 213 FT infants born between January 1, 2003 and December 31, 2008) from the Wilhelmina Children’s Hospital, Utrecht (The Netherlands). Parents reported AOIW at the neonatal follow-up outpatient clinic. Means of AOIW were compared between PT and FT born infants and with the median AOIW reported in the Bayley Scales of Infant Development-II-NL using T-test, ANOVA and Bonferroni. Results: PT born infants reached AOIW later than FT born infants (PT: mean±SD=15.2±2.8; FT: mean±SD=14.5±2.6; p=0.000). Extremely low/very low birth weight (BW) infants reached AOIW later than low/normal BW PT infants (p=0.000). Within the preterm group, being small for gestational age, severe brain abnormalities, mechanical ventilation >7 days, need of Surfactant and high-frequency oscillation were independently associated with a later AOIW (p=0.000-0.028). In the FT born group, severe brain abnormalities, post-haemorrhagic ventricular dilation and subsequent treatment was independently associated with a later AOIW (p=0.000-0.024). Compared to the norm Dutch population, NICU graduates have a higher median AOIW (p=0.000). Conclusion: The age of independent walking depends on more factors than gestational age alone. However, not all neonatal complications influence the age of onset of this milestone. V III The use of video clips in teleconsultation for preschool children with movement disorders, is this a reliable and valid method? Hetty Gorter, Cees Lucas, Karin Groothuis, Karel Maathuis, Rietje van Wijlen, Hans Elvers Purpose: Purpose of this study is to investigate reliability and validity of video clips, used in teleconsultation for preschool children with movement disorders. Methods: The reliability group consists of 27 children aged 18 to 48 months, referred on the basis of neuromotor concerns. The validity group(n=30) consists of 21 children with motor problems according to their diagnoses and 9 typical developing, aged also 18 to 48 months. The Hempel assessment is used to compare live observation of the child versus its observation on entire recording and on short video clips. Only the items dealing with spontaneous motor behaviour were included. Explorative study tested validity of the clinical classification "typical" or "suspect" based on short video clips. Results: Agreement between clinical observation of a child versus its observation from entire recording is almost perfect. Agreement in clinical classification between live observation and video recording is substantial. Agreement between entire recording and short video clips sampled from the entire recording is substantial ("6act") or moderate ("6time"). In the explorative validity study agreement between clinical classification based on short video clips and the presence of a neuromotor development disorder is substantial, but the study group is small and selective. Conclusion: Video clips of spontaneous movement behaviour can be observed reliable with the Hempel assessment of which video clips included the items of the screening are the preferable choice. Further research with larger samples of children is necessary to demonstrate if teleconsultation with short video clips can help in predicting a suspect neuromotor development. IX Echogenicity changes in the fetal brain, a six year follow-up study. Rosier-van Dunné F.M.F., van Wezel-Meijler G., de Vries J.I.P.. Objective: In preterm infants brain injury is associated with abnormal neurological development. Brain injury may have its origin before birth. The aim of the study was to evaluate the predictive value of echogenicity changes in three areas of the fetal brain for neurodevelopmental outcome until 6 year of age. Patients and Methods: Fetuses (n=124) from pregnancies affected by hypertensive disorders (n=64) or preterm labour (n=60) at risk for preterm birth (26-34 weeks gestational age) were studied. Moderate echogenicity changes (periventricular grade IB, II; intraventricular grade II-III; local basal ganglia/thalami) in the fetal and neonatal brain were related to neurological examinations, Griffith’s mental developmental scales quotients at 1, 2 and 6 years and a composite outcome (death or abnormal development). Multiple regression analysis examined the relation between moderate echogenicity changes, perinatal clinical characteristics, and composite outcome. Results: Moderate echogenicity changes were present in 37/124 (30%) fetuses. Median gestational age and weight at birth were respectively 31 weeks (range 26-43), and 1314g (range 550-4330), mortality was 18.5%. Of the 101 surviving infants 89% were examined at 1 and 2, and 67% at 6 years. Composite outcome was abnormal in 47/124 (38%). Fetal and neonatal intraventricular echodensities were related to cerebral palsy at 6 year. In the multiple regression analysis only gestational age was related to composite outcome (p= 0.005). Conclusions: In this high risk population, moderate fetal and neonatal intraventricular echodensities related to presence of cerebral palsy at 6 years. Gestational age at birth was the main predictor of abnormal composite outcome. X CORRECTION for PREMATURITY: how much and how long? J. Vanbussel PT; S. Demeester PT; P. De Cock MD, PhD; E. Ortibus MD, PhD; H. Feys PT, PhD Introduction: Research is inconclusive regarding the most appropriate method for accounting for prematurity. Therefore we studied the effect of 3 methods of correction. Subjects: 71 children, ° UZLeuven, Belgium, July 2007 -September 2010. Inclusion criteria: GA ≤ 32 weeks; BW ≤ 1251 grams. Children with CP were excluded (3/71). 49,9% were twins; 47,9% male. Mean BW 1079,79g (± 307,00g); mean GA 28 w 2d (± 2w 2d). Procedure: motor and mental scale BSID -II-NL; medical examination at 4; 9 ; 24m. Raw scores were converted into developmental indices according to three correction methods until the chronological age of 3years (full correction; linearly declining correction; no correction). Data analysis: Repeated measures ANOVA, Post Hoc Bonferroni analysis; Friedman test, Post Hoc Wilcoxon Signed Rank Test. Results: At 4 and 9m, we found significantly lower mean developmental indices for 'no correction' and 'linear correction' and significantly higher values for 'full correction'. At 24 m the difference between ‘no’ and ‘linear’ correction was no longer significant. The preterm children did not really catch up by 24 m, (PDI 84,58 for no corr; 90,02 linear; 99,52 full). (MDI 82,43 no corr; 84,69 linear; 93,21 full). Conclusion: ‘No' correction and 'full' correction result in underestimation and overestimation respectively. Therefore linear correction seems to be a good additional measure, certainly at the youngest ages, also smoothening the gap between no and full correction at the endpoint chosen. As the children do no catch up with their peers at 24m, we propose a longer correction period. XI Social cognition in 2 year old preterm children A. Verstraeten MSc (Psyc.); E. Ortibus PhD; K. Spruyt PhD Introduction: Preterm children have a higher risk of social-cognitive developmental problems. Therefore, in a pilot study, we assessed the social cognition in preterm children (two years corrected age). Hypothesis: The social cognition in preterm children is younger and/or different, even when compared to peers with an equal mental age. Subjects: We studied 5 very preterm (GA < 32 weeks) and 5 full term two year olds (corrected age). Children with severe neonatal complications, medical or motor problems were excluded. Procedure: Mental and verbal skills were measured respectively with the ‘mental scale BSID-II-NL’ and parent questionnaire N-CDI. The functional aspect of language was evaluated with ‘Evaluation of Pragmatic Skills’ (EPV2) and the social-communicative interactions with a videotaped structured observation ‘Early Social-Communication Scales’ (ESCS). Data analysis: StatSoft, Inc. (2011) Results: Mental and verbal skills were comparable in both groups. There were no significant differences regarding the functional aspect of language (EPV2) and non-verbal social skills (ESCS: initiation of and response to joint attention, behavioral request and social interaction), with the exception of one score, namely ‘response to a tickle’. Conclusion: The preterm group does (equally) well at the (corrected) age of two years regarding social cognition in comparison with full term children. On the one hand this could indicate that there are no significant differences regarding social interaction at this age. It is also possible that differences are seen insufficiently at this age either due to the sensitivity of the chosen/available instruments or the limited number of investigated children in our study. XII Visual sensory and perceptive functions in very low birth weight (VLBW) preschoolers. Geldof C.J.A.; Van Wassenaer A.G.; Kok J.H.; Oosterlaan J. Background and aim: Recent meta-analytic findings show impaired visual perceptive performance for VLBW children. Little is known about relationships between visual sensory and visual perceptive processes in VLBW children. Methods: VLBW children (n = 121) and age matched controls (n = 50) were assessed using tests for oculomotor functioning (eye position, motility, convergence, nystagmus and torticollis), visual sensory functions (visual acuity, visual field, contrast sensitivity, color perception and stereovision) and visual perceptive abilities (form and motion coherence, Position in Space, Figure-Ground, Visual Closure Form Constancy and face perception). Results: Compared to term born controls, VLBW children showed more disorders of eye position (p = .01) and convergence (p = .03). For visual sensory functions, VLBW children had lower single symbol (p <.001), but not different line symbol (p = .06) visual acuity and displayed reduced or absent stereovision more often (p = .04). Visual perceptive tasks showed reduced performance on both form and motion coherence tasks (p = .01) and on the subtests Position in Space (p = .001), Figure-Ground (p = .002), and Visual Closure (p = .03) but not on Form Constancy (p = .17). Compared to VLBW children without any oculomotor or visual sensory deficit, VLBW children with one or more of these deficits performed worse only one visual perceptive measure (Figure-Ground perception; p = .01). Discussion: We found reduced functioning in VLBW children for binocularity, perceptual grouping, visual- spatial judgment and figure-ground segmentation. Except for figure-ground segmentation, these visual perceptive deficits remain present in the absence of oculomotor and sensory deficits. XIII Visual search and attention in very low birth weight (VLBW) preschoolers. Geldof C.J.A., Van Wassenaer A.G., Kok, J.H. and Oosterlaan J. Background and aim: Very Low Birth Weight (VLBW) is associated with visual perceptive and visuomotor problems (Geldof et al., 2012). This study investigated the nature of the visual search problems in VLBW children and sought to test the hypothesis that visual search problems originate from deficits in attentional networks. Methods: Visual search and attentional network function was assessed in 105 VLBW children and 64 age matched term controls. Visual search performance was investigated with a newly developed paradigm that manipulated target density and ordering of targets. Attentional network function was measured using the Posner Attentional Network Test (ANT; Posner, 2007). Results: Visual search was less efficient in VLBW children compared to controls (F1,167 = 4.0; p =.05 partial η2 = .02). In addition, VLBW children demonstrated poor executive attention as indicated by lower accuracy levels on the executive attention measure of the ANT(p <.001; partial η2 = .08), but not on the alerting (p =.45; partial η2 = .003) and orienting (p =.32; partial η2 = .01) attention measures. None of the attention measures significantly predicted visual search efficiency (alerting: β = .24; p = .22; orienting: β = -.11; p = .65; executive attention: β = .17; p = .14). Discussion: VLBW children were characterized by less efficient visual search ability and reduced executive attention. Deficits in executive attention did not explain the deficits in visual search, suggesting that both deficits occur independently of each other. XIV Attention problems in very low birth weight preschoolers. Gijs Verkerk Aims: To compare very low birth weight (VLBW) children’s performance on attention measurements at preschool age to term-born peers, and to assess associated risk factors. Methods: Attention was assessed in 151 VLBW preschoolers and 41 term-born peers at 44 months of corrected age, using the Visual Attention task of the Developmental Neuropsychological Assessment, and the Gift Delay task. Parents completed the Attention Problems domain of the Child Behavior Checklist (CBCL- AP), the Inhibit domain of the Behavior Rating Inventory of Executive Function (preschool version), and the Inattention/Distractibility scale of the Sensory Profile. The investigator completed the Attention domain of the Miller Assessment for Preschoolers’ Behavior During Testing (BDT-AD). Potential perinatal and socio- demographic risk factors for attention problems were analyzed using logistic regression analysis. Results: Compared with term-born peers, VLBW children scored worse on five out of six attention measurements and had significantly more abnormal scores on the CBCL-AP and BDT-AD. Analyses of BDT- AD indicate that VLBW children mostly scored abnormally on the items regarding attention maintenance. Conclusions: At the time of school entry, VLBW children perform less well than their term-born peers. The CBCL-AP and BDT-AD seem sensitive tools for detecting attention problems during follow up at preschool age. XV Preterm born preschoolers’ daily disabilities in daily activities. Gijs Verkerk Aims: Do very low birth weight (VLBW) preschoolers without Cerebral Palsy (CP) have disabilities in daily activities and what are risk factors for these disabilities? Methods: Disability in daily activities was assessed with the Dutch Pediatric Evaluation of Disability Inventory (PEDI-NL) in 143 VLBW children, at 44 months corrected age (CA). Children with CP are known to have disabilities and were therefore excluded. Multiple logistic regression analyses were performed to determine the risk factors for disabilities in daily activities. Perinatal and socio-demographic factors, a low (< 1SD) Psychomotor- Developmental Index (PDI) and low (< 1SD) Mental Developmental Index (MDI) of the Bayley Scales of Infant Development (BSID II) at 24 months CA were considered as potential risk factors and included in the analyses. Results: One or more disabilities were found in 27 VLBW children (19%). The highest frequencies were found in mobility (19 (13 %) children) and in social functioning (12 (8%) children). Logistic regression analyses detected a low PDI and a low MDI as risk factors for disability in mobility; R-square .211. For disability in social functioning, a low MDI and being first born were detected as risk factors: R-square .285. Conclusions: At school entry, one in five VLBW children does have a disability in daily activities especially in mobility and social functioning which may reduce participation with their peers. However, prediction of the disabilities by risk factors is limited. Therefore, adding the PEDI to follow up assessments may enable adequate referral for intervention focussing on participation. XVI Preterm Birth and Behavioral and Emotional Problems in Early Childhood: Modifying Effects of Socioeconomic Status? Marieke R Potijk; Andrea F de Winter; Arend F Bos; Jorien M Kerstjens; Sijmen A Reijneveld. Objective: To assess whether SES modifies the relationship between moderate preterm birth and behavioral and emotional problems. Methods: Prospective cohort study consisting of a community-based sample of moderately preterm-born and term-born children. In 1,458 children, we assessed SES on the basis of education, occupation, and family income. Behavioral and emotional problems were measured at age 4, using the Child Behavior Checklist 1.5- 5 years. We determined seven syndrome scales, internalizing, externalizing, and total problems. Results: Prevalence rates of externalizing problems increased strongly as SES decreased: 9.9%, 14.4%, and 21.1% among high, intermediate, and low SES. For internalizing problems rates were 11.0%, 14.2%, and 19.5%, respectively. In multivariate logistic regression models, both SES and gestational age influenced total, externalizing, and internalizing problems (odds ratio [OR]; 95% confidence interval for total problems: 1.36; 1.10-1.68 and 1.26; 1.01-1.57, per standard deviation decrease in SES and gestational age, respectively). We found no interactions between SES and gestational age, neither after adjustment for family composition, siblings, maternal age and ethnicity, nor in separate analyses by gender, implying that their effects multiply. Thus, ORs of SES and gestational age together greatly increased the absolute risk of behavioral and emotional problems. Conclusions: Deleterious relative effects of moderate preterm birth are of similar magnitude in children of varying socioeconomic backgrounds. These new findings enlarge the knowledge on early predictors for behavioral and emotional problems in childhood and may contribute to existing and future prevention programs. XVII Association between the items of Neonatal Oral-Motor Assessment Scale and developmental outcome at 2 year in preterm infants Mechteld I.; Wolthuis-Stigter MSc; Arend F. Bos MD, PhD; Saakje P. da Costa PhD; Wim P. Krijnen PhD; Cees P. van der Schans PhD, PT, CE; Margreet R. Luinge PhD. AIM The aim of this study was to explore the association between neurodevelopment of preterm infants (2 years) and their early sucking patterns measured using the Neonatal Oral Motor Assessment Scale (NOMAS). We hypothesized that specific items of the NOMAS and the postmenstrual age (PMA) at which they were measured are related to neurodevelopment. METHOD Fifty-two preterm infants participated in this study. These infants were classified into two groups: normal development: n=39, mean GA 29.5 weeks, mean birth weight 1231g, or deviant development: n=13, mean GA 29.4 weeks, mean birth weight 1096g, based on neurological examination and/or the scores on the BSID-II-NL at the age of 2. The NOMAS was used to assess sucking patterns from 37 weeks till 50 weeks PMA. The Fisher’s Exact test was used to identify differences on NOMAS-items between the two groups. RESULTS At 44 weeks PMA a significant lower fraction of the deviant group showed a mature suck beyond appropriate age in comparison to the normal group (0.27 vs 0.70, p=0.01). The same holds for rhythmical jaw excursions (0.09 vs 0.44, p=0.04, 46 weeks PMA), rhythmical jaw movements (0.09 vs 0.44, p=0.04, 46 weeks PMA), rhythmical tongue movements (0.09 vs 0.44, p=0.04, 46 weeks PMA), and the ability to sustain suck (0.55 vs 0.88, p=0.03, 46 weeks PMA). Other items showed no significant differences. INTERPRETATION Difficulties in sucking skills concerning consistency and rhythm persisting until early post term period (44-46 weeks PMA) were in particular associated with deviant neurodevelopment. XVIII Development of sucking pattern in preterm infants. Mrs. Saakje P. da Costa, PhD. Preterm infants often have problems learning to suckle at the breast or to drink from a bottle. It is unclear whether this is due to their preterm birth or whether it is the consequence of neurological damage. Knowledge about the development of sucking patterns in preterm infants and the ability to recognise the risk factors and indicators of abnormalities will provide paediatricians and nurses insight in how they could best set up oral feeding schedules. We studied the development of sucking patterns in preterm infants from the time the infant started feeding orally until the age of ten weeks post-term. At weekly intervals we observed sucking, swallowing and respiration with the aid of the Neonatal Oral-Motor Assessment Scale (NOMAS). The development of sucking patterns in preterms differs from that of healthy, fullterm infants: three quarters of the preterms developed a normal sucking pattern later than fullterm infants did, especially it differs in preterms with intrauterine growth retardation and very preterm with and without a BPD (< 28 weeks’ PMA) require extra attention when oral feeding schedules are set up. It is important, therefore, to check carefully whether a preterm infant is ready to start feeding orally. When oral feeding actually commences, it is important to monitor carefully whether the infant keeps in control of its physiological parameters and recovers rapidly after a feed. In the care of preterm infants, close collaboration between all people involved, is of vital importance. Examples of adequate start and monitoring of oral feeding will be shown and explained. Participants Aarnoudse -Moens Cornelieke Psycholoog Alyward Glen Spreker Baar, van Anneloes Hoogleraar Pedagogische wetenschappen Bakker Catharina Kinderarts Balen, van Thea GZ -psycholoog Barten Suzanna Kinderarts Bax Caroline Gynaecoloog Beld, van den Susan Kinderfysiotherapeut Berg, van den Roxanne Student Beuger Sabine Kinderarts/neonatoloog Beukers Fenny student Boelen Caroline Kinderfysiotherapeut Boer, de Rosa Kinderfysiotherapie Boon, de Karin Ergotherapeut Boons Corita Kinderfysiotherapeut Both-Vogel Margriet Jeugdarts KNMG Braeckel, van Koenraad Neuropsycholoog Brand Madelon Kinderarts Broeck, van de Christine Professor Broring Tinka Medisch psycholoog Brouwer Mieke Verpleegkundig onderzoeker Buiter Hannah Kinderarts/Neonatoloog Bussel, van Jeannine Fysiotherapeut Caesar Alexandra Kinderarts/neonatoloog Charbon prof Gerard speciale gast Conneman Nikk Kinderarts/neonatoloog Costa, da Saakje Logopedist Coul, op de Moniek Kinderarts Craje Celine Post doctoral researcher Derickx Rosemarie Ergotherapeut Derks Elna Logopedist Derks Jan Perinatoloog Deslee Jo Kinesiste Dik Marjolein Neuropsycholoog Dijk van, Gesina Kinderfysiotherapeut Dongen, van Minouche Kinderarts Driessen Dorin Kinderfysiotherapeut Egmond van-Dam van, Janneke Kinderfysiotherapeut Eijsermans Rian Pediatric Physical Therapist Enderink Inez Medisch psycholoog Engels Michelle Logopedist Enk, van Gert Kinderarts Eshuis Geja Kinderfysiotherapeut Frima Rinske Gezondheidszorgpsycholoog Geldof Christiaan Psycholoog Gijn van, Kattendijke van, May Kinderfysiotherapeut Godthelp-Kortink Chris EoP-med./fysiotherapeute Gorter Hetty Kinderfysiotherapeut Haan, de Timo Neonatolloog/kinderarts Haastert, van Ingrid Orthopedagoog/fysiotherapeut Hatif Fareeda Jeugdarts Hamer Elisa MD/PhD student Heide, van der Maaike Kinderarts Heide van der, Jalving Marjanneke Kinderarts/Neonatoloog Heijden, van der Esther NIDCAP consulent/kinderfysiotherapeut Heinerman Bianca Kinderarts Hegeman Anneke Kinderfysiotherapeut Henny Civile Kinderfysiotherapeut Herbers Ineke Klinisch verloskundige Heuts Ingrid Kinderarts Heyden, van der Zita Vz Ver. Van Ouders van Couveuzekinderen Himpens Eveline Post doctoral researcher Hoffmann-haringsm Angelique Neonatoloog/kinderarts Hollander Martine Gynaecoloog Hooft, van 't Janneke arts-ass. Gynaecologie/onderzoeker Hornman Jorijn Student Hove, ten Christine Kinderarts/fellow Neonatologie Hus, van Janeline Kinderfysiotherapeut/PhD student Huisman Martine Psycholoog Iersel, van Patricia Kinderfysiotherapeut Impe, van Hilde Kinesitherapeute Janssen Anjo Fysiotherapeut Jong, de Marjanneke PhD student Jongbloed-Pereboom Marjolein PhD student Jongsma-de Vries Caren Kinderfysiotherapeut Jongmans Marian Psycholoog Katwijk, van Wilma Kinderfysiotherapeut Kempen, van Anne Kinderarts/neonatoloog Kenter Sandra Kinderarts Kerstjens Jorien Kinderarts/Neonatoloog Kleine, de Martin Neonatoloog/kinderarts Klink, van Jeanine Psycholoog Kok Joke Hoogleraar neonatologie Kok-Wijesinha Indrani Kinderarts Koldewijn Karen Opleidingscoord. Expertisecentrum Ontwik. Ondersteuning prematuren Koning Els Kinderfysiotherapeut Koomen Alice Psycholoog Koopmans Cornine Psycholoog/neonatoloog Korpershoek Jan Kinderfysiotherapeut Laarman Celeste Neonatoloog/kinderarts Laroche Sabine Neonatoloog/kinderarts Lier, van Monique Psychiater Lieshout, van Marjolein Senior Scientist Luinge Margreet Lector Kind, Taal en Ontwikkeling Maingay Dianne Kinderarts-neonatoloog Mader Silke EFCNI Marlow Neil Spreker Meijssen Dominique Psycholoog Mertens Lisanne Psycholoog Molderink Alice klinisch psycholoog/psychotherapeut Mulder Susanne Neonatoloog Naarding Eveline Jeugdarts KNMG Nieuwenhuis Tjitske student Nijhuis-Sanden van der Ria Noort, van-Spek, van der Inge Linguist Nooyer, de Annemiek student / helpt mee tijdens congres Noyon Ruth Jeugdarts Nuysink Jacqueline Pediatric Physical Therapist Oldeman Inge Kinderfysiotherapeut Oosterlaan Jaap workshop begeleider Oosterwoud Impy kinderverpleegkundige Oostrom Kim Clinical neuropsychologist Ortibus Els MD Osch van Brenda Jounaliste/Schrijver Otten Marie-Anne (pre)logopediste Oude Reimer Monique NIDCAP consulent Oudkerk Heleen Fysiotherapeut Pampus, van Marielle Perinatoloog Pel Maria Obstetrist Poppel van, Meijdern, v/d Esther Kinderfysiotherapeut Potharst Eva promovenda Potijk (A. de Winter komt) Marieke student Ramdass Pratimah Kumari paediatric & neonatol intensive care doctor Reinaerts Irene Kinderfysiotherapeut Reuser Jolanda GZ-psycholoog Rondelez Eveline Psycholoog Rosenbrand Marjan Kinderfysiotherapeut Rosier-van Dunne Fleur Gynaecoloog Roukema Joke Kinderfysiotherapeut Rouse Dwight spreker Rijken Monique Neonatoloog Rijksen Ingrid AIOS gynaecologie Sagius Annemiek PT Sattele Vanessa Consultant product design Schakel Ellen kinderfysiotherapeut Scheurer Nienke Kinderarts/kinderneuroloog Schie, van Petra kinderfysiotherapeut/onderzoeker Schipper J.A. Kinderarts Schmitt Dorine Kinderfysiotherapeut Schoenmaker Diana Kinder- en jeugdpsycholoog Schotman Jolande kinderfysiotherapeut Schuerman Frank Kinderarts/neonatoloog Schuitevoerder Kim Kinderarts Selman Bea kinderfysiotherapeut Sickinghe Fleur Speech therapist Slobbe-Burema Rita Kinderfysiotherapeut Smit L.S. Ped. neurologist Sneekes Siska Kinderfysiotherapeut Sonderen, van Loekie Neonatoloog Stam, van Caroline Psycholoog Steenbrugge, van Gert Jan Voorzitter vereniging ouders van couveuse kinderen Steenis Leonie PhD student Steggerda Sylke Neonatoloog/kinderarts Steiner Katerina Kinderarts/neonatoloog Stoelhorst Gerlinde Kinderarts/neonatoloog Theeuwes Jacintha Kinderfysiotherapeut Turennout, van Angelique Psycholoog Utens Elisabeth Research coord ped. psychology Veel Barbara vereniging ouders van couv kinderen/ hoofdredactuer Kleine Maatjes Veenendaal, van Mariette Kinderarts/Neonatoloog Veere, van der Christa Kinderarts Verdoorn AnneMarie Logopedist Verhoeve Anoek Kinderfysiotherapeut Verkerk Gijs PhD student/occupational therapist Vermeulen Jeroen Kinderneuroloog Verstraeten Annelies Centre for Developmental Disabilities Visman Karen Kinderfysiotherapeut Voogt Anja Wagemaker-Verkerk Greet Kinderfysiotherapeut Wassenaer, van Aleid Neonatoloog Wassenberg Renske GZ-psycholoog Weisglas-Kuperus Nynke Kinderarts Weller-Vogel Sandra Kinderfysiotherapeut Werner-Wafelman Leontien Kinderarts Westrup Bjorn Spreker Wijnberg-Williams Barbara Pediatrisch psycholoog Winter de, Andrea Wolf Marie-Jeanne workshop begeleider Wolthuis-Stigter Mechteld Psycholoog Wulms Diana Kinderfysiotherapeute Ziel, van der Mirjam Psychotherapist Zoet Ingrid GZ psy Ken J psycholoog Zonnenberg Inge Kinderarts/neonatoloog Momentary Exhibition: Impressionism: Sensation & Inspiration Highlights from the Hermitage 16 June 2012 – 13 January 2013 From 16 June 2012 to 13 January 2013, the Hermitage Amsterdam will present Impressionism: Sensation & Inspiration: the world-famous Impressionist paintings from the vast collection of the State Hermitage Museum in St. Petersburg, in their artistic context. Masterpieces by pioneers like Claude Monet, Pierre-Auguste Renoir, Alfred Sisley, and Camille Pissarro will be accompanied by the work of other influential French painters from the second half of the nineteenth century, such as Eugène Delacroix and Jean-Léon Gérôme. The exhibition will focus on contrasts between artistic movements. For instance, visitors will see and experience the sensational quality of Impressionism, the movement that heralded a new age. All the paintings, drawings, and sculptures will come from the collection of the St. Petersburg Hermitage. Seldom has such a rich survey of this period been on display in the Netherlands. 1 Sensation Impressionism derives its name from Monet's painting Impression, soleil levant (1872); the name was first used mockingly by a journalist, but was soon adopted as a badge of pride. These artists rendered their fleeting impressions in vibrant colours for the pure pleasure of painting. They had no use for lofty ideas and worked in the open air under ever-changing light. The Impressionists brought a breath of fresh air to the stuffy art world of their day. Their subjects are easy to appreciate. Along with city scenes and landscapes, they often depicted the most charming aspects of everyday bourgeois life: Paris cafés and boulevards, seaside excursions, informal portraits, and rowing trips just outside town. The revolutionary ideas of this new generation clashed with the reigning academic tradition. Their colourful ‘impressions’ were seen as shocking and radical, and at first they were frequent targets of ridicule. Yet their radical approach to style, technique, and subject matter proved deeply inspiring to many artists. They ushered in a new perspective on reality, a new concept of beauty, a new era. 2 Inspiration Impressionism began as a response to the classicism of the Paris Salon, an annual exhibition of officially selected art. The exponents of this style painted precisely as artists were expected to paint: carefully staged scenes with crisp outlines and an eye for detail. Their subjects were mythological, historical, or religious. The most prominent artists in the neo-classicist tradition were Alexandre Cabanel (Portrait of Countess Elizabeth Vorontsova-Dashkova, 1873) and Jean-Léon Gérôme (Sale of a Slave Girl in Rome [Slave Market in Ancient Rome], 1884). One of the best-known French Romantics is Eugène Delacroix (Lion Hunt in Morocco, 1854). Painters such as Théodore Rousseau (Landscape with a Ploughman, 1860-1865) and Charles-François Daubigny (Pool, 1858) represent the Barbizon School. They can be seen as forerunners of the Impressionists, because they painted their realistic landscapes in the open air. The exhibition will deliberately place the Impressionists in the company of their predecessors, contemporaries, and successors, including both kindred spirits and competing movements. Favourites like Monet's Woman in the Garden and Renoir's Portrait of the Actress Jeanne Samary will be side by side with the work of Delacroix, Daubigny and Gérôme, as well as magnificent paintings by Paul Cézanne (The Smoker, c. 1890–1892) and Paul Gauguin (Woman with Fruit, 1893), who were inspired by Impressionism to develop wholly original, personal styles. In short, the Hermitage Amsterdam will offer a clear and fascinating overview of the many currents and controversies in the turbulent French art scene between 1850 and 1900. 3 The Van Gogh Museum at the Hermitage When Cézanne and Gauguin are mentioned, a third artist cannot be overlooked: Vincent van Gogh, their equally original and brilliant contemporary, who was also indebted to the Impressionists. As the leading post-Impressionist, he explored the limits of the movement. On 29 September, a large portion of the Van Gogh Museum collection will be relocated to the Hermitage Amsterdam, including 75 highlights, works on paper, and a selection from the letters. The two exhibition wings will then both be open to the public. Never before has the famous Van Gogh collection been on display under the same roof as so many famous French contemporaries from the Hermitage. More information: http://www.hermitage.nl/