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Thompson SCH, Treyvaud K, Pascoe L, Mainzer RM, Nguyen TNN, Inder TE, Doyle LW, Anderson PJ. Trajectories of social outcomes in individuals born very preterm from childhood to adolescence. Acta Paediatr 2024. [PMID: 39327828 DOI: 10.1111/apa.17434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 09/11/2024] [Accepted: 09/12/2024] [Indexed: 09/28/2024]
Abstract
AIM To compare trajectories of social functioning in peer problems and prosocial behavior from 5 to 13 years between individuals born very preterm (VPT) and full-term (FT). METHODS Participants were from the Victorian Infant Brain Study (VIBeS) longitudinal cohort, consisting of 224 individuals born VPT and 77 born FT recruited at birth. Social functioning was measured using the parent-rated Strengths and Difficulties Questionnaire (SDQ) peer problems and prosocial behavior subscales at 5, 7, and 13 years' corrected age. Multilevel mixed effects models were fitted. RESULTS Peer problems increased with age (adjusted mean difference per year = 0.04, 95% confidence interval [CI] = 0.01, 0.07, p = 0.02), with higher peer problems in the VPT compared with the FT group (adjusted mean difference between groups = 0.46, 95% CI = 0.06, 0.86, p = 0.02). Prosocial behavior increased from early to middle childhood and decreased approaching adolescence, but was similar between VPT and FT groups (adjusted mean difference between groups = -0.05, 95% CI = -0.50, 0.40, p = 0.82). CONCLUSION Children born VPT are at greater risk for peer problems than FT peers and may benefit from receiving greater early social support.
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Affiliation(s)
- Sarah C H Thompson
- School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Karli Treyvaud
- School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Leona Pascoe
- School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
- Centre for Community and Child Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Rheanna M Mainzer
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Thi-Nhu-Ngoc Nguyen
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Terrie E Inder
- Center for Neonatal Research, Children's Hospital of Orange County, Orange County, California, USA
- Department of Pediatrics, School of Medicine, University of California Irvine, Orange County, California, USA
| | - Lex W Doyle
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne, Parkville, Victoria, Australia
- Newborn Research Centre, The Royal Women's Hospital and University of Melbourne, Parkville, Victoria, Australia
| | - Peter J Anderson
- School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Center for Neonatal Research, Children's Hospital of Orange County, Orange County, California, USA
- Department of Pediatrics, School of Medicine, University of California Irvine, Orange County, California, USA
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Spiegler J, El-Awad U, Baumann N, Lemola S, Wolke D. Participation in club sport in childhood is associated with mental health in preterm and term born adolescents. Eur Child Adolesc Psychiatry 2024; 33:2823-2830. [PMID: 38291168 PMCID: PMC11272685 DOI: 10.1007/s00787-023-02365-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 12/20/2023] [Indexed: 02/01/2024]
Abstract
Preterm born individuals have an increased risk for mental health problems. Participation in club sport is associated with better mental health but the causal direction is unclear. It is not known whether this association could also be found in preterm children. Data from term born (N = 10,368), late preterm (N = 630), and very to moderately preterm born (N = 243) children from the Millennium Cohort Study at the ages of 3, 5, 7, 11, and 14 years were used. Longitudinal associations between the parent-reported Strengths and Difficulties questionnaire (SDQ) and club sport participation (days per week) were analysed using multigroup structural equation modelling, adjusting for gender, maternal depression, parental education; motor problems and attrition were controlled for. Multi-group structural equation modelling showed that children with more peer relationship problems, emotional symptoms, conduct problems or hyperactivity-inattention were less likely to participate in club sport at subsequent assessment time points. More days with club sport participation was associated with lower levels of emotional symptoms and peer relationship problems but not conduct problems or hyperactivity-inattention at subsequent ages. Results were similar in all gestational age groups. Club sport participation predicts lower levels of peer relationship and emotional problems in subsequent waves while it is also predicted by lower levels of emotional problems, peer relationship problems, conduct problems and hyperactivity-inattention in preceding waves. Since no differences in the relationship between SDQ subscales and club sport participation were seen with regard to gestational age groups, club sport should be encouraged in all children.
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Affiliation(s)
- Juliane Spiegler
- Department of Paediatrics, University Hospital of Würzburg, Josef-Schneider-Strasse 2, 97080, Würzburg, Germany.
- Department of Psychology, University of Warwick, University Road, Coventry, CV4 7AL, UK.
| | - Usama El-Awad
- Faculty of Psychology and Sports Sciences, University of Bielefeld, P.O. Box 10 01 31, 33501, Bielefeld, Germany
| | - Nicole Baumann
- Department of Psychology, University of Warwick, University Road, Coventry, CV4 7AL, UK
- Department of Population Health Sciences, University of Leicester, University Road, Leicester, LE1 7RH, UK
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Level 5, 18 Innovation Walk, Clayton Campus, Melbourne, VIC, 3800, Australia
| | - Sakari Lemola
- Department of Psychology, University of Warwick, University Road, Coventry, CV4 7AL, UK
- Faculty of Psychology and Sports Sciences, University of Bielefeld, P.O. Box 10 01 31, 33501, Bielefeld, Germany
| | - Dieter Wolke
- Department of Psychology, University of Warwick, University Road, Coventry, CV4 7AL, UK
- Division of Mental Health & Wellbeing, University of Warwick, University Road, Coventry, CV4 7AL, UK
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Oh WO, Heo YJ. Early Parenting Interventions to Enhance Development in Infants and Children Born Prematurely: A Systematic Review and Meta-Analysis. J Pediatr Health Care 2024:S0891-5245(24)00148-2. [PMID: 39023458 DOI: 10.1016/j.pedhc.2024.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 06/08/2024] [Accepted: 06/08/2024] [Indexed: 07/20/2024]
Abstract
INTRODUCTION Parenting interventions have the potential to become effective strategies for improving the developmental trajectories of infants and children born prematurely. However, the effectiveness of parenting interventions is not well understood. METHODS A literature search was conducted in five databases. A total of 24 studies involving 3,636 participants were included for review. RESULTS The results showed a significant effect in cognition, language, motor development, and behavioral problems of children born prematurely. Parenting stress, anxiety, and interactive behaviors showed significant effect size. DISCUSSION This review focuses on interventions that employ scaffolding parenting strategies to enhance the development of children born prematurely. Efforts should continue to empower parents through effective and sustainable parenting interventions to improve the quality of life of preterm children.
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Affiliation(s)
- Won-Oak Oh
- Won-Oak Oh, Professor and Yoo-Jin Heo, Post-Doctoral Researcher, College of Nursing, Korea University, Seoul, South Korea
| | - Yoo-Jin Heo
- Won-Oak Oh, Professor and Yoo-Jin Heo, Post-Doctoral Researcher, College of Nursing, Korea University, Seoul, South Korea.
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4
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Nwanne OY, Rogers ML, McGowan EC, Tucker R, Vivier PM, Vohr BR. High-risk neighbourhoods and behaviour outcomes in children born extremely preterm. Acta Paediatr 2024; 113:1555-1561. [PMID: 38597231 DOI: 10.1111/apa.17236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/20/2024] [Accepted: 04/02/2024] [Indexed: 04/11/2024]
Abstract
AIM Study the association between neighbourhood risk and behaviour in extreme preterm (EPT) children. We hypothesised that EPT children living in high-risk neighbourhoods have increased risk of clinical range behaviour problems at age 30-36 months. METHODS Retrospective analyses of Child Behavior Checklist (CBCL)scores for 739 EPTs born 2005-2016. Addresses were geocoded to identify census block groups and create high versus low-risk groups. Regression analyses assessed the impact of neighbourhood risk on behaviour. RESULTS Children from high-risk (N = 272, 39%) and low-risk (N = 417, 61%) neighbourhoods were compared. In adjusted analyses, odds of clinical range scores remained greater in high-risk neighbourhoods for Emotionally Reactive (OR: 4.32, CI: 1.13, 16.51), Somatic Complaints (2.30, CI 1.11,4.79), Withdrawn (OR: 2.56, CI: 1.21, 5,42), Aggressive Behaviour (OR: 4.12, CI: 1.45, 11.68), Internalising (OR: 1.96, CI: 1.17, 3.28), and Total score (OR: 1.86, OR: CI: 1.13, 3.07). Cognitive delay was higher in high-risk neighbourhoods and a risk factor for Attention Problems (2.10,1.08, 4.09). Breast milk was protective for Emotionally Reactive (OR: 0.22, CI: 0.06, 0.85) and Sleep Problems (OR: 0.47, CI:0.24, 0.94). CONCLUSION Neighbourhood risk provided an independent contribution to preterm adverse behaviour outcomes with cognitive delay an additional independent risk factor. Breast milk at discharge was protective.
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Affiliation(s)
- Ogochukwu Y Nwanne
- Division of Neonatal Medicine, Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Department of Pediatrics, Women and Infants Hospital, Providence, Rhode Island, USA
- Department of Pediatrics, St Mary's Hospital Athens, Athens, Georgia, USA
| | - Michelle L Rogers
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Elisabeth C McGowan
- Division of Neonatal Medicine, Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Department of Pediatrics, Women and Infants Hospital, Providence, Rhode Island, USA
| | - Richard Tucker
- Department of Pediatrics, Women and Infants Hospital, Providence, Rhode Island, USA
| | - Patrick M Vivier
- College of Health Sciences, University of Rhode Island, Kingston, Rhode Island, USA
| | - Betty R Vohr
- Division of Neonatal Medicine, Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Department of Pediatrics, Women and Infants Hospital, Providence, Rhode Island, USA
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5
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Jansen L, Steggerda S, Rijken M, van Steenis A, de Vries L, Peeters-Scholte C, Vermeiren R, van Klink J. Social-emotional and behavioural issues after very preterm birth: Parental and teachers experiences. J Child Health Care 2024; 28:277-290. [PMID: 35993442 DOI: 10.1177/13674935221121881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Preterm infants are at risk of developing social-emotional and behavioural difficulties. To understand the experiences of their caregivers in day-to-day life, parents (at 2 and 10 years) and teachers (at 10 years) completed a behavioural questionnaire and answered two open-ended questions addressing their concerns and the most positive aspects regarding their child and/or pupil (born <32 weeks gestation). Their answers were analyzed using thematic content analysis. Parental concerns at two years related equally to themes in the clusters Developmental Milestones, Physical Development and Development in Relation to the Self and Others. At 10 years, both parents and teachers reported mainly within the cluster Development in Relation to the Self and Others, but the underlying themes differed. While parents more often mentioned their child's emotional development, teachers were more concerned about their pupils' difficulties interacting with their peers, due to a lack of social skills. In-depth qualitative analysis of what parents and teachers experience from day-to-day improves our understanding of the social-emotional and behavioural development of children born very preterm, revealing important topics that should be addressed during follow-up.
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Affiliation(s)
- Lisette Jansen
- Department of Medical Psychology, Leiden University Medical Center, Leiden, Netherlands
- Curium-LUMC Department of Child and Adolescent Psychiatry, Leiden University Medical Center, Leiden, Netherlands
| | - Sylke Steggerda
- Department of Neonatology, Leiden University Medical Center, Leiden, Netherlands
| | - Monique Rijken
- Department of Neonatology, Leiden University Medical Center, Leiden, Netherlands
| | - Andrea van Steenis
- Department of Neonatology, Leiden University Medical Center, Leiden, Netherlands
| | - Linda de Vries
- Department of Neonatology, Leiden University Medical Center, Leiden, Netherlands
| | | | - Robert Vermeiren
- Curium-LUMC Department of Child and Adolescent Psychiatry, Leiden University Medical Center, Leiden, Netherlands
- Youz, Parnassia Psychiatric Institute, The Hague, The Netherlands
| | - Jeanine van Klink
- Department of Medical Psychology, Leiden University Medical Center, Leiden, Netherlands
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Vittner D, Butler S, Lawhon G, Buehler D. The newborn individualised developmental care and assessment program: A model of care for infants and families in hospital settings. Acta Paediatr 2024. [PMID: 38816927 DOI: 10.1111/apa.17300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 05/03/2024] [Accepted: 05/08/2024] [Indexed: 06/01/2024]
Abstract
AIM The Newborn Individualised Developmental Care and Assessment Program (NIDCAP) is an intervention and education programme that uses developmental observation for multidisciplinary healthcare professionals (HCP) caring for high-risk infants and families. Infants prosper with the ongoing co-regulation process of infant and family that is influenced by the physical and social environment. METHODS The Template for Intervention Description and Replication (TIDieR) Guidelines were applied to the NIDCAP intervention. The estimation of the individual infant's current goals is described from direct observation of behaviour in the context of ongoing care delivery. The infant's behaviour guides all caregivers to articulate current strengths and functioning for the development of individualised plans of care and support. The NIDCAP Nursery Program supports the full integration of NIDCAP into the healthcare system. RESULTS NIDCAP is a system-based, process-oriented, attuned and responsive intervention for individualised developmental care for infants and families. Evidence shows NIDCAP significantly improves medical outcomes, with less time on the ventilator, improved weight gain, decreased length of stay, improved developmental outcomes and enhanced infant and family relationships. Evidence suggests that NIDCAP as an intervention improves parental competence, decreases stress for HCP teams and improves HCP satisfaction. CONCLUSION NIDCAP improves outcomes for infants and families requiring hospital care.
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Affiliation(s)
- Dorothy Vittner
- Egan School of Nursing and Health Studies, Fairfield University, Fairfield, Connecticut, USA
- Neonatal Intensive Care Unit, Connecticut Children's, Hartford, Connecticut, USA
- West Coast NIDCAP & APIB Training Center, San Francisco, California, USA
- National NIDCAP Training Center, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Samantha Butler
- National NIDCAP Training Center, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Boston Children's, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Gretchen Lawhon
- West Coast NIDCAP & APIB Training Center, San Francisco, California, USA
- Newborn Special Care Associates, PC, Abington Jefferson Health, Abington, Pennsylvania, USA
| | - Deborah Buehler
- West Coast NIDCAP & APIB Training Center, San Francisco, California, USA
- Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA
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7
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Smith-Longee A, Johnson S, Aubert AM, Seppänen AV, Pierrat V, Zemlin M, Lebeer J, Sarrechia I, Siljehav V, Zeitlin J, Sentenac M. The early educational environment at five years of age in a European cohort of children born very preterm: challenges and opportunities for research. BMC Pediatr 2024; 24:369. [PMID: 38807056 PMCID: PMC11134723 DOI: 10.1186/s12887-024-04792-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 04/25/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND Early childhood education offers opportunities for stimulation in multiple developmental domains and its positive impact on long-term outcomes and wellbeing for children is well documented. Few studies have explored early education in children born very preterm (VPT; <32 weeks of gestation) who are at higher risk of neurodevelopmental disorders and poor educational outcomes than their term-born peers. The purpose of the study is to describe and compare the educational environment of children born VPT in European countries at 5 years of age according to the degree of perinatal risk. METHODS Data originated from the population-based Screening to Improve Health In very Preterm infants (SHIPS) cohort of children born VPT in 2011/2012 in 19 regions from 11 European countries. Perinatal data were collected from medical records and the 5-year follow-up was conducted using parental questionnaires. Outcomes at 5 years were participation in early education (any, type, intensity of participation) and receipt of special educational support, which were harmonized across countries. RESULTS Out of 6,759 eligible children, 3,687 (54.6%) were followed up at 5 years (mean gestational age 29.3 weeks). At 5 years, almost all children (98.6%) were in an educational program, but type (preschool/primary), attendance (full-time/part-time) and use and type of school support/services differed by country. In some countries, children with high perinatal risk were more likely to be in full-time education than those with low risk (e.g. Estonia: 97.9% vs. 87.1%), while the inverse pattern was observed elsewhere (e.g. Poland: 78.5% vs. 92.8%). Overall, 22.8% of children received special educational support (country range: 12.4-34.4%) with more support received by children with higher perinatal risk. Large variations between countries remained after adjustment for socio-demographic characteristics. CONCLUSIONS There are marked variations in approaches to early education for children born VPT in Europe, raising opportunities to explore its impact on their neurodevelopment and well-being.
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Affiliation(s)
- Alyssa Smith-Longee
- Université Paris Cité, Inserm, INRAE, Centre for Research in Epidemiology and Statistics (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Paris, France
| | - Samantha Johnson
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Adrien M Aubert
- Université Paris Cité, Inserm, INRAE, Centre for Research in Epidemiology and Statistics (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Paris, France
| | - Anna-Veera Seppänen
- Université Paris Cité, Inserm, INRAE, Centre for Research in Epidemiology and Statistics (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Paris, France
| | - Veronique Pierrat
- Université Paris Cité, Inserm, INRAE, Centre for Research in Epidemiology and Statistics (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Paris, France
- Department of Neonatalogy, CHI Créteil, Créteil, F-94028, France
| | - Michael Zemlin
- Department of General Paediatrics and Neonatology, Saarland University, Saarland University Medical School, Homburg, Germany
| | - Jo Lebeer
- Department of Medicine & Population Health, Faculty of Medicine & Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Iemke Sarrechia
- Department of Medicine & Population Health, Faculty of Medicine & Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Veronica Siljehav
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Jennifer Zeitlin
- Université Paris Cité, Inserm, INRAE, Centre for Research in Epidemiology and Statistics (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Paris, France
| | - Mariane Sentenac
- Université Paris Cité, Inserm, INRAE, Centre for Research in Epidemiology and Statistics (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Paris, France.
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8
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van Beek PE, Rijken M, Broeders L, Ter Horst HJ, Koopman-Esseboom C, de Kort E, Laarman ARC, Mulder-de Tollenaer SM, Steiner K, Swarte RMC, van Westering-Kroon E, Oei G, Leemhuis AG, Andriessen P. Neurodevelopmental outcome at 5.5 years in Dutch preterm infants born at 24-26 weeks' gestational age: the EPI-DAF study. Arch Dis Child Fetal Neonatal Ed 2024; 109:272-278. [PMID: 38071564 DOI: 10.1136/archdischild-2023-325732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 10/20/2023] [Indexed: 04/20/2024]
Abstract
OBJECTIVE After lowering the Dutch threshold for active treatment from 25 to 24 completed weeks' gestation, survival to discharge increased by 10% in extremely preterm live born infants. Now that this guideline has been implemented, an accurate description of neurodevelopmental outcome at school age is needed. DESIGN Population-based cohort study. SETTING All neonatal intensive care units in the Netherlands. PATIENTS All infants born between 240/7 and 266/7 weeks' gestation who were 5.5 years' corrected age (CA) in 2018-2020 were included. MAIN OUTCOME MEASURES Main outcome measure was neurodevelopmental outcome at 5.5 years. Neurodevelopmental outcome was a composite outcome defined as none, mild or moderate-to-severe impairment (further defined as neurodevelopmental impairment (NDI)), using corrected cognitive score (Wechsler Preschool and Primary Scale of Intelligence Scale-III-NL), neurological examination and neurosensory function. Additionally, motor score (Movement Assessment Battery for Children-2-NL) was assessed. All assessments were done as part of the nationwide, standardised follow-up programme. RESULTS In the 3-year period, a total of 632 infants survived to 5.5 years' CA. Data were available for 484 infants (77%). At 5.5 years' CA, most cognitive and motor (sub)scales were significantly lower compared with the normative mean. Overall, 46% had no impairment, 36% had mild impairment and 18% had NDI. NDI-free survival was 30%, 49% and 67% in live born children at 24, 25 and 26 weeks' gestation, respectively (p<0.001). CONCLUSIONS After lowering the threshold for supporting active treatment from 25 to 24 completed weeks' gestation, a considerable proportion of the surviving extremely preterm children did not have any impairment at 5.5 years' CA.
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Affiliation(s)
- Pauline E van Beek
- Department of Neonatology, Máxima Medical Center, Veldhoven, The Netherlands
| | - Monique Rijken
- Department of Neonatology, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands
| | - Lisa Broeders
- The Netherlands Perinatal Registry, Utrecht, The Netherlands
| | - Hendrik J Ter Horst
- Department of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands
| | - Corine Koopman-Esseboom
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ellen de Kort
- Department of Neonatology, Máxima Medical Center, Veldhoven, The Netherlands
| | - A R C Laarman
- Department of Neonatology, Amsterdam University Medical Center location VUMC, Amsterdam, The Netherlands
| | | | - Katerina Steiner
- Department of Neonatology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Renate M C Swarte
- Department of Neonatology, Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Guid Oei
- Department of Obstetrics and Gynaecology, Máxima Medical Center, Veldhoven, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Aleid G Leemhuis
- Department of Neonatology, Emma Childrens' Hospital, Amsterdam University Medical Center location AMC, Amsterdam, The Netherlands
| | - Peter Andriessen
- Department of Neonatology, Máxima Medical Center, Veldhoven, The Netherlands
- Department of Applied Physics, School of Medical Physics and Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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Fernández de Gamarra-Oca L, Lucas-Jiménez O, Ontañón JM, Loureiro-Gonzalez B, Peña J, Ibarretxe-Bilbao N, García-Guerrero MA, Ojeda N, Zubiaurre-Elorza L. Amygdala structure and function and its associations with social-emotional outcomes in a low-risk preterm sample. Brain Struct Funct 2024; 229:477-488. [PMID: 38236400 PMCID: PMC10917835 DOI: 10.1007/s00429-023-02749-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 12/04/2023] [Indexed: 01/19/2024]
Abstract
Amygdala atypical volume development and functional connectivity (FC) at small gestational ages (GA) have been found across childhood. This adult-oriented study assesses whether altered amygdala structure and function is present following low-risk preterm birth. T1-weighted and resting-state functional MRI images of 33 low-risk preterm (30-36 weeks' GA) and 29 full-term (37-42 weeks' GA) young adults of both sexes, aged between 20 and 32 years old, were analyzed using FreeSurfer (v6.0.0) and Coon Toolbox (v21.a). The social-emotional assessment included Happé's Strange Stories Test, the Moral Judgment Test, Delay-Discounting Test, Adult Self Report, and Emotion Regulation Questionnaire. No differences were found in social-emotional outcomes or amygdala volumes between the groups. Low-risk preterm young adults showed increased FC between the left amygdala, right amygdala and medial frontal cortex (MedFC) (F = 9.89, p-FWE = 0.009) at cluster level compared to their full-term peers. However, significant results at connection level were not observed between left and right amygdala. Lastly, increased FC at cluster level between the right amygdala and MedFC, and left amygdala and MedFC, was related to better social-emotional outcomes only in low-risk preterm young adults (F = 6.60, p-FWE = 0.036) at cluster level. At connection level, in contrast, only right amygdala-MedFC increased FC was significantly associated with better social-emotional outcomes. This study reveals that low-risk prematurity does not have an effect on social-emotional outcomes or structural amygdala volumes during young adulthood. However, individuals who were considered to be at a lower risk of exhibiting neurodevelopmental alterations following preterm birth demonstrated increased FC between the left and right amygdala and MedFC.
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Affiliation(s)
| | - O Lucas-Jiménez
- Department of Psychology, Faculty of Health Sciences, University of Deusto, Bilbao, Bizkaia, Spain
| | - J M Ontañón
- OSATEK, MR Unit, Galdakao Hospital, Galdakao, Spain
| | - B Loureiro-Gonzalez
- Division of Neonatology, Biocruces Health Research Institute, Cruces University Hospital, Barakaldo, Bizkaia, Spain
| | - J Peña
- Department of Psychology, Faculty of Health Sciences, University of Deusto, Bilbao, Bizkaia, Spain
| | - N Ibarretxe-Bilbao
- Department of Psychology, Faculty of Health Sciences, University of Deusto, Bilbao, Bizkaia, Spain
| | - M A García-Guerrero
- Department of Psychology, Faculty of Health Sciences, University of Deusto, Bilbao, Bizkaia, Spain
| | - N Ojeda
- Department of Psychology, Faculty of Health Sciences, University of Deusto, Bilbao, Bizkaia, Spain
| | - L Zubiaurre-Elorza
- Department of Psychology, Faculty of Health Sciences, University of Deusto, Bilbao, Bizkaia, Spain.
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Deferm W, Tang T, Moerkerke M, Daniels N, Steyaert J, Alaerts K, Ortibus E, Naulaers G, Boets B. Subtle microstructural alterations in white matter tracts involved in socio-emotional processing after very preterm birth. Neuroimage Clin 2024; 41:103580. [PMID: 38401459 PMCID: PMC10944182 DOI: 10.1016/j.nicl.2024.103580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/10/2024] [Accepted: 02/10/2024] [Indexed: 02/26/2024]
Abstract
Children born very preterm (VPT, < 32 weeks of gestation) have an increased risk of developing socio-emotional difficulties. Possible neural substrates for these socio-emotional difficulties are alterations in the structural connectivity of the social brain due to premature birth. The objective of the current study was to study microstructural white matter integrity in VPT versus full-term (FT) born school-aged children along twelve white matter tracts involved in socio-emotional processing. Diffusion MRI scans were obtained from a sample of 35 VPT and 38 FT 8-to-12-year-old children. Tractography was performed using TractSeg, a state-of-the-art neural network-based approach, which offers investigation of detailed tract profiles of fractional anisotropy (FA). Group differences in FA along the tracts were investigated using both a traditional and complementary functional data analysis approach. Exploratory correlations were performed between the Social Responsiveness Scale (SRS-2), a parent-report questionnaire assessing difficulties in social functioning, and FA along the tract. Both analyses showed significant reductions in FA for the VPT group along the middle portion of the right SLF I and an anterior portion of the left SLF II. These group differences possibly indicate altered white matter maturation due to premature birth and may contribute to altered functional connectivity in the Theory of Mind network which has been documented in earlier work with VPT samples. Apart from reduced social motivation in the VPT group, there were no significant group differences in reported social functioning, as assessed by SRS-2. We found that in the VPT group higher FA values in segments of the left SLF I and right SLF II were associated with better social functioning. Surprisingly, the opposite was found for segments in the right IFO, where higher FA values were associated with worse reported social functioning. Since no significant correlations were found for the FT group, this relationship may be specific for VPT children. The current study overcomes methodological limitations of previous studies by more accurately segmenting white matter tracts using constrained spherical deconvolution based tractography, by applying complementary tractometry analysis approaches to estimate changes in FA more accurately, and by investigating the FA profile along the three components of the SLF.
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Affiliation(s)
- Ward Deferm
- Center for Developmental Psychiatry, KU Leuven, Belgium.
| | - Tiffany Tang
- Center for Developmental Psychiatry, KU Leuven, Belgium
| | | | - Nicky Daniels
- Neuromotor Rehabilitation Research Group, KU Leuven, Belgium
| | - Jean Steyaert
- Center for Developmental Psychiatry, KU Leuven, Belgium; Child Psychiatry, UZ Leuven, Belgium
| | - Kaat Alaerts
- Neuromotor Rehabilitation Research Group, KU Leuven, Belgium
| | | | - Gunnar Naulaers
- Neonatal Intensive Care Unit - Neonatology, UZ Leuven, Belgium; UZ Leuven & Center for Developmental Disorders, Belgium
| | - Bart Boets
- Center for Developmental Psychiatry, KU Leuven, Belgium
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Leppänen M, Pape B, Ripatti L, Karukivi M, Haataja L, Rautava P. Burden of mental, behavioral, and neurodevelopmental disorders in the Finnish most preterm children: a national register study. Eur Child Adolesc Psychiatry 2024; 33:431-438. [PMID: 36847865 PMCID: PMC10869390 DOI: 10.1007/s00787-023-02172-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 02/14/2023] [Indexed: 03/01/2023]
Abstract
Etiologies and the whole picture in childhood mental, behavioral, and neurodevelopmental disorders related to gestational age are unclear. This study included all Finnish children (N = 341,632) born between January 1, 2001, and December 31, 2006, whose data including their mothers (N = 241,284) were collected from national registers. Children with unclear gestational age (GA) (N = 1245), severe congenital malformations (N = 11,746), and moderate/severe/undefined cognitive impairment (N = 1140), and those who died during the perinatal period (N = 599) were excluded. The main outcome was the prevalence of mental and behavioral disorders (International Classification of Disorders) at 0 - 12 years of age in association with GA, adjusted for gender and prenatal variables. Out of all included (N = 326,902) children 16.6% (N = 54,270) were diagnosed to have any mental health disorder at 0 - 12 years. Adjusted Odd Ratio (OR) were for any disorder in preterm (< 37 weeks) 1.37 [1.28 - 1.46] and 4.03 [3.08 - 5.26] in extreme preterm (≤ 28 weeks) versus term born children, p < 0.05. The lower the GA at birth, the higher the risk for multiple disorders and earlier onset of disorder, p < 0.05. Adjusted ORs were for male/female 1.94 [1.90 - 1.99], maternal mental health disorder (yes/not) 1.99 [1.92 - 2.07], and smoking during pregnancy (yes/not) 1.58 [1.54 - 1.62], and these risks were more common in preterm versus term born children (p < 0.05). Extreme early birth was a strong risk factor per se for any or multiple and early shown mental health disorders. Other risk factors for mental health accumulated to preterm children.
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Affiliation(s)
- Marika Leppänen
- Neuropsychiatric Outpatient Clinic, Turku University Hospital, and Preventive Medicine, University of Turku, 20014, Turun Yliopisto, Turku, Finland.
| | - Bernd Pape
- Department of Mathematics and Statistics, University of Vaasa, and Turku University Hospital, Turku, Finland
| | - Liisi Ripatti
- Department of Pediatric Surgery, Turku University Hospital, Turku, Finland
| | - Max Karukivi
- Department of Adolescent Psychiatry, University of Turku, and Turku University Hospital, Turku, Finland
| | - Leena Haataja
- Department of Pediatric Neurology, Pediatric Research Centre, University of Helsinki, and Children's Hospital, Helsinki University Hospital, Helsinki, Finland
| | - Päivi Rautava
- Research Services, Turku University Hospital, and Preventive Medicine, University of Turku, Turku, Finland
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12
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Fisher AP, Miley AE, Glazer S, Gies LM, Parikh NA, Lam L, Wade SL. Feasibility and acceptability of an online parenting intervention to address behaviour problems in moderately to extremely preterm pre-school and school-age children. Child Care Health Dev 2024; 50:e13209. [PMID: 38100158 DOI: 10.1111/cch.13209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 09/08/2023] [Accepted: 11/18/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND Preterm birth is associated with adverse mental health outcomes, including internalizing problems, social difficulties and inattention. Interventions are needed beyond infancy and toddlerhood to support children and their families. We examined the feasibility and acceptability of the I-InTERACT Preterm pilot study, an online parenting intervention for preterm children ages 3-8. METHOD Families participated in a weekly intervention comprised of seven sessions with online modules followed by videoconference coaching sessions with a therapist. Following completion of the study, caregivers completed a survey to assess their satisfaction and were asked to participate in a voluntary semi-structured interview to provide feedback. We anticipated greater than a 50% participation rate (enrollment feasibility) and 75% completion rate (adherence feasibility). We also hypothesized that at least 80% of participants would be satisfied with the intervention (acceptability). RESULTS Nineteen of 32 families (59%) enrolled in the study, suggesting adequate enrollment feasibility. Feasibility of programme completion (adherence) was lower than anticipated (59%). Regarding satisfaction, all caregivers agreed that the programme's information was relevant to them and their family. Nearly all participants (92%) indicated that they had a better understanding of the effects of preterm birth on behaviour, that they enjoyed the programme, that it met their expectations and that they recommend the programme to others. In qualitative interviews, caregivers expressed satisfaction with the content, skills they learned, and receiving direct coaching. Caregivers suggested improvements to increase intervention feasibility and skill implementation, including offering biweekly sessions and more hands-on coaching. CONCLUSION Our largely satisfactory acceptability rates suggest the value of and need for a parenting intervention for children born preterm past the initial period of early development. Future directions include modifying the intervention in response to caregiver feedback to improve recruitment, engagement and adherence.
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Affiliation(s)
- Allison P Fisher
- Division of Pediatric Rehabilitation Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Aimee E Miley
- Neurodevelopmental Disorders Prevention Center, Perinatal Institute, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Sandra Glazer
- Division of Pediatric Rehabilitation Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Psychology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Lisa M Gies
- Division of Pediatric Rehabilitation Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Nehal A Parikh
- Neurodevelopmental Disorders Prevention Center, Perinatal Institute, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Leo Lam
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Shari L Wade
- Division of Pediatric Rehabilitation Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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13
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Serenius F, Kaul YF, Källén K, Hafström M, Ådén U, Stjernqvist K, Farooqi A. Neurobehavioral symptoms in children born extremely preterm: A Swedish National Study. Acta Paediatr 2023; 112:2387-2399. [PMID: 37551108 DOI: 10.1111/apa.16942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 08/03/2023] [Accepted: 08/07/2023] [Indexed: 08/09/2023]
Abstract
AIM To determine the prevalence of neurobehavioral symptoms at 6.5 years in children born extremely preterm (EPT, <27 weeks' gestation). METHODS Population-based cohort study of infants born EPT in Sweden from 2004 to 2007. Of 486 survivors 375 were assessed and compared with 369 matched term-born controls. EPT children free from neurosensory and intellectual disabilities (neurodevelopmental disabilities [NDD]-free, n = 236) were compared separately. Standardised questionnaires were used to assess parental ratings of hyperactivity and attention, emotional, peer-relation, conduct and social problems; and deficits in perception, language and memory. RESULTS EPT children had more reported problems in all assessed neurobehavioral domains than controls, with more than three times greater odds for most outcomes. Except for conduct problems, increased problems were identified also in NDD-free children. The odds of having neurobehavioral problems in ≥3 co-occurring domains were five (whole EPT group) and three (NDD-free group) times higher than in controls. CONCLUSION EPT children with or without NDD have more neurobehavioral problems in multiple domains than term peers. Ongoing assessments of behaviour until school age or beyond should recognise early symptoms of attention, everyday social problems, perceptual, emotional or language difficulties.
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Affiliation(s)
- Fredrik Serenius
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Department of Neonatology, Child and Adolescent Medicine, Umeå University Hospital, Umeå, Sweden
| | | | - Karin Källén
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Lund, University of Lund, Lund, Sweden
| | - Maria Hafström
- Department of Paediatrics, Institute of Clinical Science, University of Gothenburg, Gothenburg, Sweden
- Angered Hospital, Gothenburg, Sweden
| | - Ulrika Ådén
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Karin Stjernqvist
- Department of Clinical Sciences, Pediatric Section, Lund University, Lund, Sweden
- Department of Neonatal Care and Pediatric Surgery, Skåne University Hospital, Lund, Sweden
| | - Aijaz Farooqi
- Department of Neonatology, Child and Adolescent Medicine, Umeå University Hospital, Umeå, Sweden
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14
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Bousquet A, Sanderson K, O’Shea TM, Fry RC. Accelerated Aging and the Life Course of Individuals Born Preterm. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1683. [PMID: 37892346 PMCID: PMC10605448 DOI: 10.3390/children10101683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 09/29/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023]
Abstract
Individuals born preterm have shorter lifespans and elevated rates of chronic illness that contribute to mortality risk when compared to individuals born at term. Emerging evidence suggests that individuals born preterm or of low birthweight also exhibit physiologic and cellular biomarkers of accelerated aging. It is unclear whether, and to what extent, accelerated aging contributes to a higher risk of chronic illness and mortality among individuals born preterm. Here, we review accelerated aging phenotypes in adults born preterm and biological pathways that appear to contribute to accelerated aging. We highlight biomarkers of accelerated aging and various resiliency factors, including both pharmacologic and non-pharmacologic factors, that might buffer the propensity for accelerated aging among individuals born preterm.
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Affiliation(s)
- Audrey Bousquet
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA; (A.B.); (R.C.F.)
| | - Keia Sanderson
- Department of Internal Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC 27599, USA;
| | - T. Michael O’Shea
- Department of Pediatrics, School of Medicine, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Rebecca C. Fry
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA; (A.B.); (R.C.F.)
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15
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Patronick J, Glazer S, Sidol C, Parikh NA, Wade SL. Parenting Interventions Targeting Behavior for Children Born Preterm or Low Birth Weight: A Systematic Review. J Pediatr Psychol 2023; 48:676-687. [PMID: 37290433 DOI: 10.1093/jpepsy/jsad031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 05/17/2023] [Accepted: 05/18/2023] [Indexed: 06/10/2023] Open
Abstract
OBJECTIVE To systematically review and summarize the outcomes of parenting interventions designed to improve child and/or parenting behavior for children born preterm and/or low birth weight (LBW). METHODS We conducted systematic searches of Embase, Scopus, PubMed, PsycInfo, and CINAHL in September 2021. We identified articles published at any time that describe the outcomes of parenting interventions targeting the child and/or parenting behavior of children born preterm/LBW and their caregivers. Two independent raters assessed the risk of bias using the Revised Cochrane Risk-of-Bias Tool. RESULTS Eight hundred sixteen titles and abstracts were screened, followed by 71 full-text articles, resulting in 24 eligible articles reporting on nine interventions with 1,676 participants. Eligible articles had an adequate risk of bias ratings. Sample characteristics, intervention components, and intervention effects were tabulated and described narratively by the intervention type. Preventative and treatment programs demonstrated positive intervention effects on externalizing behavior, parenting stress, and parenting behaviors, with mixed effects on internalizing behavior and emotion regulation. The few studies with longitudinal follow-up found little evidence of effects beyond 6 months postintervention. CONCLUSION Behavior problems in children born preterm/LBW may be modifiable, and interventions targeting parenting behavior are promising. However, existing interventions may not produce long-lasting changes and are not designed for children older than four. Existing treatment programs may require adaptation for the neurocognitive, medical, and family needs of children born preterm/LBW (e.g., processing speed deficits, post-traumatic stress). Interventions that account for theories of sustained change may promote long-term effectiveness and the developmental tailoring of parenting skills.
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Affiliation(s)
- Jamie Patronick
- Department of Psychology, University of Cincinnati, USA
- Division of Physical Medicine and Rehabilitation, Cincinnati Children's Hospital Medical Center, USA
| | - Sandra Glazer
- Department of Psychology, University of Cincinnati, USA
- Division of Physical Medicine and Rehabilitation, Cincinnati Children's Hospital Medical Center, USA
| | - Craig Sidol
- Division of Physical Medicine and Rehabilitation, Cincinnati Children's Hospital Medical Center, USA
| | - Nehal A Parikh
- The Perinatal Institute, Cincinnati Children's Hospital Medical Center, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, USA
| | - Shari L Wade
- Division of Physical Medicine and Rehabilitation, Cincinnati Children's Hospital Medical Center, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, USA
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16
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Valois R, Tojal C, Barros H, Costa R. [Formula: see text] Perinatal and social risk of poor language, memory, and learning outcomes in a cohort of extremely and very preterm children. Child Neuropsychol 2023; 29:906-921. [PMID: 36343685 DOI: 10.1080/09297049.2022.2138845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 10/14/2022] [Indexed: 11/09/2022]
Abstract
Children born extremely preterm (EPT) or very preterm (VPT) are at risk of neurodevelopmental impairment. How the interaction between biological and social risk factors affects cognitive development has not yet been completely understood. The objectives of this study are to analyze and compare the language, memory, and learning outcomes of five-year-old children born EPT (<28 weeks' gestational age) and VPT (28-31+6 weeks' gestational age) and to determine the risk of having poor outcomes attending to perinatal and maternal characteristics. The analysis included 377 children born VPT (n = 284) and EPT (n = 93) in 2011-2012. Maternal, neonatal, and clinical information was obtained at birth, and maternal education was obtained at five years using a parental questionnaire. At five years, the language, memory, and learning outcomes were assessed with the developmental NEuroPSYchological assessment second edition (NEPSY-II®). Logistic regression models were applied to assess the association of biological and social risk factors with performance below the expected level for the child's age in language, memory, and learning subtests. Lower maternal age and education increased the odds of having language performance below the expected level for the child's age, while lower maternal educational level and gestational age increased the likelihood of having memory performance below the expected level. Children living in the most social disadvantage contexts are at a higher risk of suboptimal cognitive development. Implementing intervention programs in disadvantaged contexts and targeting specific cognitive domains may enable EPT and VPT children to reach and fulfill their potential in society.
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Affiliation(s)
- Rachel Valois
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Matosinhos Public Health Unit, Matosinhos Local Health Unit, Matosinhos, Portugal
| | - Catarina Tojal
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal
| | - Henrique Barros
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal
- Public Health and Forensic Sciences, and Medical Education Department, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Raquel Costa
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal
- HEI-Lab: Digital Human-Environment Interactions Lab, Lusofona University, Lisbon, Portugal
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17
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Robert de Saint Vincent M, Rouger V, Rozé JC, Flamant C, Muller JB. Assessing Behavioral Disorders with SDQ in Very Preterm Children at 5 Years of Age in LIFT Cohort. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1191. [PMID: 37508688 PMCID: PMC10378436 DOI: 10.3390/children10071191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/20/2023] [Accepted: 06/30/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND Preterm-born children are at risk of behavioral disorders and the systematic assessment of these disorders remains a challenge. Questions remain about the accuracy of self-reported parent questionnaires and the real everyday life behavior of the child. AIM To evaluate the association between SDQ reported by parents in the preterm and behavioral difficulties in the everyday school life environment reported by teacher. METHODS All children born before 33 weeks and who followed-up in the LIFT (Loire Infant Follow-up team) network were included. The Strengths and Difficulties Parental Questionnaire (SDQ), completed at 5 years, was used to check for behavioral difficulties and identified three groups: "normal", "borderline" and "abnormal". Then, the SDQ results were compared to the Global School Adaptation Score (GSA) at 5 years. RESULTS Out of the 1825 children followed in the cohort at the age of 5, 1397 questionnaires were analyzed. A total of 11.1% of children had an abnormal score, and 9.7% had a borderline score. Male gender and a lower birth weight z-score were significantly associated with the "abnormal SDQ" group. There is a significant relationship between the probability of being in the "abnormal SDQ" group at 5 years and with difficulty in global school adaptation at 5 years, as well as an SDQ borderline score in the preterm (p < 0.001). CONCLUSIONS SDQ abnormal and borderline scores are associated with behavioral difficulties in the classroom and everyday life behavior. In preterm children, one should be alerted even by a borderline SDQ score.
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Affiliation(s)
- Marine Robert de Saint Vincent
- Department of Neonatal Medicine, University Hospital of Nantes, 44000 Nantes, France
- Loire Infant Follow-Up Team (LIFT) Network, 44000 Nantes, France
| | - Valérie Rouger
- Loire Infant Follow-Up Team (LIFT) Network, 44000 Nantes, France
- National Institute of Health and Medical Research, CIC 1413, University Hospital of Nantes, 44000 Nantes, France
| | - Jean Christophe Rozé
- Department of Neonatal Medicine, University Hospital of Nantes, 44000 Nantes, France
- Loire Infant Follow-Up Team (LIFT) Network, 44000 Nantes, France
- National Institute of Health and Medical Research, CIC 1413, University Hospital of Nantes, 44000 Nantes, France
| | - Cyril Flamant
- Department of Neonatal Medicine, University Hospital of Nantes, 44000 Nantes, France
- Loire Infant Follow-Up Team (LIFT) Network, 44000 Nantes, France
- National Institute of Health and Medical Research, CIC 1413, University Hospital of Nantes, 44000 Nantes, France
| | - Jean-Baptiste Muller
- Department of Neonatal Medicine, University Hospital of Nantes, 44000 Nantes, France
- Loire Infant Follow-Up Team (LIFT) Network, 44000 Nantes, France
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18
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Morales MF, Girard LC, Sawrikar V, MacBeth A. An examination of behavioural and emotional problems in children exposed prenatally to the 27F Chilean earthquake: findings from the ELPI cohort. Soc Psychiatry Psychiatr Epidemiol 2023; 58:1065-1073. [PMID: 36799991 PMCID: PMC10261207 DOI: 10.1007/s00127-023-02433-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 02/02/2023] [Indexed: 02/18/2023]
Abstract
PURPOSE Associations between prenatal earthquake exposure and children's mental health remain unclear. Moreover, there is a paucity of research using quasi-experimental statistical techniques to diminish potential selection bias. Thus, this study aimed to explore the impact of prenatal exposure to the Chilean earthquake of 2010 on children's behavioural and emotional problems between 1½ and 3 years old using propensity score matching. METHODS Participants included 1549 families from the Encuesta Longitudinal de la Primera Infancia cohort in Chile. Maternal reports using the Child Behaviour Checklist (CBCL) were used to assess behavioural and emotional problems between 1½ and 3 years old. Information on prenatal earthquake exposure was collected via maternal report. The Kernel matching estimator was used to compare the average treatment effects of children who were exposed to the earthquake compared to those who were not. RESULTS Five of the seven CBCL outcomes were statistically significant after matching and adjustment for multiple testing, suggesting greater difficulties for exposed children which included emotional reactivity, anxious/depressed, sleep problems, attention problems, and aggression (mean difference of 0.69, 0.87, 0.73, 0.85, 3.51, respectively). The magnitude of the effect was small to medium. CONCLUSION Findings contribute to the potential causal inferences between prenatal earthquake exposure and increased behavioural and emotional problems in early childhood. Results suggest that in utero experiences may have long-term consequences for infants' well-being, supporting the need for specific interventions in pregnancy after natural disasters.
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Affiliation(s)
- María Francisca Morales
- Department of Clinical Psychology, School of Health in Social Science, The University of Edinburgh, Edinburgh, UK.
| | | | - Vilas Sawrikar
- Department of Clinical Psychology, School of Health in Social Science, The University of Edinburgh, Edinburgh, UK
| | - Angus MacBeth
- Department of Clinical Psychology, School of Health in Social Science, The University of Edinburgh, Edinburgh, UK
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19
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Enelamah NV, Lombe M, Yu M, Villodas ML, Foell A, Newransky C, Smith LC, Nebbitt V. Structural and Intermediary Social Determinants of Health and the Emotional and Behavioral Health of US Children. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1100. [PMID: 37508597 PMCID: PMC10377858 DOI: 10.3390/children10071100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 06/09/2023] [Accepted: 06/12/2023] [Indexed: 07/30/2023]
Abstract
Children grow up in homes where varying environmental and socioeconomic contexts have a bearing on their emotional and behavioral health (EBH). This study used data from a representative sample of the child supplement of the US National Health Information Survey (NHIS) and applied the social determinants of health (SDoH) framework to explore factors associated with child EBH. We conducted a path analysis of the child's EBH measured by the strengths and difficulties questionnaire (SDQ) from their macro and socioeconomic contexts, e.g., policy, household, and other health system risk factors. For children in the sample, aged 4 to 17 years old (n = 9205), most path relationships to child SDQ scores were statistically significant. The total effects from a child's visit to a mental health specialist (0.28) and child's age (0.22) had the highest coefficients to child SDQ scores. A modified model showed a better fit with X2 (4) = 22.124, RMSEA = 0.021, and 90% CI [0.013-0.03], CFI = 0.98. Findings indicate that child factors such as being older, the use of mental healthcare services, and family socioeconomic status were significantly associated with EBH, calling attention to the need for more responsive policy and behavioral health interventions that address household/familial and child-level factors, critical determinants of child wellbeing.
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Affiliation(s)
- Ngozi V Enelamah
- Department of Social Work, College of Health and Human Services, University of New Hampshire, Durham, NH 03824, USA
| | - Margaret Lombe
- School of Social Work, Boston University, Boston, MA 02215, USA
| | - Mansoo Yu
- School of Social Work, Department of Public Health, College of Health Sciences, University of Missouri, Columbia, MO 65211, USA
| | - Melissa L Villodas
- Department of Social Work, College of Public Health, George Mason University, Fairfax, VA 22030, USA
| | - Andrew Foell
- Jane Addams College of Social Work, University of Illinois, Chicago, IL 60612, USA
| | | | - Lisa C Smith
- The Grace Abbott School of Social Work, University of Nebraska-Omaha, Omaha, NE 68198, USA
| | - Von Nebbitt
- The Grace Abbott School of Social Work, University of Nebraska-Omaha, Omaha, NE 68198, USA
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20
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Kvanta H, Bolk J, Broström L, Fernández de Gamarra-Oca L, Padilla N, Ådén U. Extreme prematurity and perinatal risk factors related to extremely preterm birth are associated with complex patterns of regional brain volume alterations at 10 years of age: a voxel-based morphometry study. Front Neurol 2023; 14:1148781. [PMID: 37273719 PMCID: PMC10235462 DOI: 10.3389/fneur.2023.1148781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 04/28/2023] [Indexed: 06/06/2023] Open
Abstract
Objective Structural brain volumetric differences have been investigated previously in very preterm children. However, children born extremely preterm, at the border of viability, have been studied to a lesser degree. Our group previously analyzed children born extremely preterm at term using voxel-based morphometry. In this study, we aimed to examine regional gray and white matter differences for children born extremely preterm derived from the same cohort during childhood. We also aimed to explore the effect of perinatal risk factors on brain volumes in the same group. Methods At 10 years of age, 51 children born extremely preterm (before 27 weeks and 0 days) and 38 term-born controls with high-quality 3.0 Tesla magnetic resonance images were included. Statistical analyses using voxel-based morphometry were conducted on images that were normalized using age-specific templates, modulated, and smoothed. Analyses were also performed in stratified groups of children born extremely preterm in the absence or presence of perinatal risk factors that have previously been shown to be associated with volumetric differences at term. Results We found volumetric decreases in gray and white matter in the temporal lobes, gray matter decreases in the precuneus gyri, and white matter decreases in the anterior cingulum for children born extremely preterm (all p < 0.001, and pfwe < 0.05). Gray and white matter increases were predominantly observed in the right posterior cingulum and occipital lobe (all p < 0.001, and pfwe < 0.05). Of the examined perinatal risk factors, intraventricular hemorrhage grades I-II compared with no intraventricular hemorrhage and patent ductus arteriosus ligation compared with no treated patent ductus arteriosus or patent ductus arteriosus treated with ibuprofen led to volumetric differences at 10 years of age (all p < 0.001, and pfwe < 0.05). Conclusions Children born extremely preterm exhibit volumetric alterations in a pattern overlapping that previously found at term, where many regions with differences are the main hubs of higher order networks. Some, but not all, risk factors known to be associated with structural alterations at term were associated with alterations at 10 years of age.
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Affiliation(s)
- Hedvig Kvanta
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Jenny Bolk
- Clinical Epidemiology Division, Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Lina Broström
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | | | - Nelly Padilla
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Ulrika Ådén
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
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21
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Mäkilä E, Ekblad MO, Rautava P, Lapinleimu H, Setänen S. Five-to-Fifteen-Parental Perception of Developmental Profile from Age 5 to 8 Years in Children Born Very Preterm. J Pers Med 2023; 13:jpm13050819. [PMID: 37240989 DOI: 10.3390/jpm13050819] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/09/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023] Open
Abstract
Children born very preterm have increased risk of developmental difficulties. We examined the parental perception of developmental profile of children born very preterm at 5 and 8 years by using the parental questionnaire Five-to-Fifteen (FTF) compared to full-term controls. We also studied the correlation between these age points. The study included 168 and 164 children born very preterm (gestational age < 32 weeks and/or birth weight ≤ 1500 g) and 151 and 131 full-term controls. The rate ratios (RR) were adjusted for sex and the father's educational level. At 5 and 8 years, children born very preterm were more likely to have higher scores (more difficulties) compared to controls in motor skills (RR = 2.3, CI 95% = 1.8-3.0 at 5 years and RR = 2.2, CI 95% = 1.7-2.9 at 8 years), executive function (1.7, 1.3-2.2 and 1.5, 1.2-2.0), perception (1.9, 1.4-2.5 and 1.9, 1.5-2.5), language (1.5, 1.1-1.9 and 2.2, 1.7-2.9), and social skills (1.4, 1.1-1.8 and 2.1, 1.6-2.7), and at 8 years in learning (1.9, 1.4-2.6) and memory (1.5, 1.2-2.0). There were moderate-to-strong correlations (r = 0.56-0.76, p < 0.001) in all domains between 5 and 8 years in children born very preterm. Our findings suggest that FTF might help to earlier identify children at the greatest risk of incurring developmental difficulties persisting to school-age.
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Affiliation(s)
- Eeva Mäkilä
- Department of Pediatric Neurology, University of Turku, 20014 Turku, Finland
- Salo Health Centre, 24240 Salo, Finland
| | - Mikael O Ekblad
- Department of General Practice, Institute of Clinical Medicine, Turku University Hospital, University of Turku, 20014 Turku, Finland
| | - Päivi Rautava
- Public Health, Turku Clinical Research Centre, Turku University Hospital, University of Turku, 20014 Turku, Finland
| | - Helena Lapinleimu
- Department of Pediatrics, Turku University Hospital, University of Turku, 20014 Turku, Finland
| | - Sirkku Setänen
- Department of Pediatric Neurology, University of Turku, 20014 Turku, Finland
- Department of Pediatrics, Turku University Hospital, University of Turku, 20014 Turku, Finland
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22
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Hofheimer JA, McGrath M, Musci R, Wu G, Polk S, Blackwell CK, Stroustrup A, Annett RD, Aschner J, Carter BS, Check J, Conradt E, Croen LA, Dunlop AL, Elliott AJ, Law A, Leve LD, Neiderhiser JM, O’Shea TM, Salisbury AL, Sathyanarayana S, Singh R, Smith LM, Aguiar A, Angal J, Carliner H, McEvoy C, Ondersma SJ, Lester B. Assessment of Psychosocial and Neonatal Risk Factors for Trajectories of Behavioral Dysregulation Among Young Children From 18 to 72 Months of Age. JAMA Netw Open 2023; 6:e2310059. [PMID: 37099294 PMCID: PMC10134008 DOI: 10.1001/jamanetworkopen.2023.10059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/10/2023] [Indexed: 04/27/2023] Open
Abstract
Importance Emotional and behavioral dysregulation during early childhood are associated with severe psychiatric, behavioral, and cognitive disorders through adulthood. Identifying the earliest antecedents of persisting emotional and behavioral dysregulation can inform risk detection practices and targeted interventions to promote adaptive developmental trajectories among at-risk children. Objective To characterize children's emotional and behavioral regulation trajectories and examine risk factors associated with persisting dysregulation across early childhood. Design, Setting, and Participants This cohort study examined data from 20 United States cohorts participating in Environmental influences on Child Health Outcomes, which included 3934 mother-child pairs (singleton births) from 1990 to 2019. Statistical analysis was performed from January to August 2022. Exposures Standardized self-reports and medical data ascertained maternal, child, and environmental characteristics, including prenatal substance exposures, preterm birth, and multiple psychosocial adversities. Main Outcomes and Measures Child Behavior Checklist caregiver reports at 18 to 72 months of age, with Dysregulation Profile (CBCL-DP = sum of anxiety/depression, attention, and aggression). Results The sample included 3934 mother-child pairs studied at 18 to 72 months. Among the mothers, 718 (18.7%) were Hispanic, 275 (7.2%) were non-Hispanic Asian, 1220 (31.8%) were non-Hispanic Black, 1412 (36.9%) were non-Hispanic White; 3501 (89.7%) were at least 21 years of age at delivery. Among the children, 2093 (53.2%) were male, 1178 of 2143 with Psychosocial Adversity Index [PAI] data (55.0%) experienced multiple psychosocial adversities, 1148 (29.2%) were exposed prenatally to at least 1 psychoactive substance, and 3066 (80.2%) were term-born (≥37 weeks' gestation). Growth mixture modeling characterized a 3-class CBCL-DP trajectory model: high and increasing (2.3% [n = 89]), borderline and stable (12.3% [n = 479]), and low and decreasing (85.6% [n = 3366]). Children in high and borderline dysregulation trajectories had more prevalent maternal psychological challenges (29.4%-50.0%). Multinomial logistic regression analyses indicated that children born preterm were more likely to be in the high dysregulation trajectory (adjusted odds ratio [aOR], 2.76; 95% CI, 2.08-3.65; P < .001) or borderline dysregulation trajectory (aOR, 1.36; 95% CI, 1.06-1.76; P = .02) vs low dysregulation trajectory. High vs low dysregulation trajectories were less prevalent for girls compared with boys (aOR, 0.60; 95% CI, 0.36-1.01; P = .05) and children with lower PAI (aOR, 1.94; 95% CI, 1.51-2.49; P < .001). Combined increases in PAI and prenatal substance exposures were associated with increased odds of high vs borderline dysregulation (aOR, 1.28; 95% CI, 1.08-1.53; P = .006) and decreased odds of low vs high dysregulation (aOR, 0.77; 95% CI, 0.64-0.92; P = .005). Conclusions and Relevance In this cohort study of behavioral dysregulation trajectories, associations were found with early risk factors. These findings may inform screening and diagnostic practices for addressing observed precursors of persisting dysregulation as they emerge among at-risk children.
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Affiliation(s)
- Julie A. Hofheimer
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill
- Department of Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill
| | - Monica McGrath
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Rashelle Musci
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Guojing Wu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Sarah Polk
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Courtney K. Blackwell
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Annemarie Stroustrup
- Division of Neonatology, Department of Pediatrics, Cohen Children’s Medical Center at Northwell Health, New Hyde Park, New York
| | - Robert D. Annett
- Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque
| | - Judy Aschner
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York
- Hackensack Meridian School of Medicine, Nutley, New Jersey
| | - Brian S. Carter
- Department of Pediatrics, University of Missouri-Kansas City, Children’s Mercy Kansas City, Kansas City
| | - Jennifer Check
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Elisabeth Conradt
- Department of Psychiatry, Duke University School of Medicine, Durham, North Carolina
| | - Lisa A. Croen
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Anne L. Dunlop
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia
| | - Amy J. Elliott
- Avera Research Institute, Sioux Falls, South Dakota
- Department of Pediatrics, University of South Dakota School of Medicine, Sioux Falls
| | - Andrew Law
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Leslie D. Leve
- Prevention Science Institute, University of Oregon, Eugene
| | | | - T. Michael O’Shea
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill
| | | | - Sheela Sathyanarayana
- Department of Pediatrics, University of Washington, Seattle Children’s Research Institute, Seattle
| | - Rachana Singh
- Department of Pediatrics, Tufts University School of Medicine, Boston, Massachusetts
| | - Lynne M. Smith
- Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, California
| | - Andréa Aguiar
- Department of Comparative Biosciences, University of Illinois at Urbana-Champaign, Urbana-Champaign
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana-Champaign
| | - Jyoti Angal
- Avera Research Institute, Sioux Falls, South Dakota
| | - Hannah Carliner
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Cindy McEvoy
- Department of Pediatrics, Oregon Health & Science University, Doernbecher Children’s Hospital, Portland
| | - Steven J. Ondersma
- Division of Public Health, Michigan State University, East Lansing
- Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, East Lansing
| | - Barry Lester
- Brown Center for the Study of Children at Risk, Women & Infants Hospital, Brown University Alpert School of Medicine, Providence
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23
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Robinson R, Girchenko P, Pulakka A, Heinonen K, Lähdepuro A, Lahti-Pulkkinen M, Hovi P, Tikanmäki M, Bartmann P, Lano A, Doyle LW, Anderson PJ, Cheong JLY, Darlow BA, Woodward LJ, Horwood LJ, Indredavik MS, Evensen KAI, Marlow N, Johnson S, de Mendonca MG, Kajantie E, Wolke D, Räikkönen K. ADHD symptoms and diagnosis in adult preterms: systematic review, IPD meta-analysis, and register-linkage study. Pediatr Res 2023; 93:1399-1409. [PMID: 34997222 PMCID: PMC10132969 DOI: 10.1038/s41390-021-01929-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 12/07/2021] [Accepted: 12/14/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND This study examined differences in ADHD symptoms and diagnosis between preterm and term-born adults (≥18 years), and tested if ADHD is related to gestational age, birth weight, multiple births, or neonatal complications in preterm borns. METHODS (1) A systematic review compared ADHD symptom self-reports and diagnosis between preterm and term-born adults published in PubMed, Web of Science, and PROQUEST until April 2021; (2) a one-stage Individual Participant Data(IPD) meta-analysis (n = 1385 preterm, n = 1633 term; born 1978-1995) examined differences in self-reported ADHD symptoms[age 18-36 years]; and (3) a population-based register-linkage study of all live births in Finland (01/01/1987-31/12/1998; n = 37538 preterm, n = 691,616 term) examined ADHD diagnosis risk in adulthood (≥18 years) until 31/12/2016. RESULTS Systematic review results were conflicting. In the IPD meta-analysis, ADHD symptoms levels were similar across groups (mean z-score difference 0.00;95% confidence interval [95% CI] -0.07, 0.07). Whereas in the register-linkage study, adults born preterm had a higher relative risk (RR) for ADHD diagnosis compared to term controls (RR = 1.26, 95% CI 1.12, 1.41, p < 0.001). Among preterms, as gestation length (RR = 0.93, 95% CI 0.89, 0.97, p < 0.001) and SD birth weight z-score (RR = 0.88, 95% CI 0.80, 0.97, p < 0.001) increased, ADHD risk decreased. CONCLUSIONS While preterm adults may not report higher levels of ADHD symptoms, their risk of ADHD diagnosis in adulthood is higher. IMPACT Preterm-born adults do not self-report higher levels of ADHD symptoms, yet are more likely to receive an ADHD diagnosis in adulthood compared to term-borns. Previous evidence has consisted of limited sample sizes of adults and used different methods with inconsistent findings. This study assessed adult self-reported symptoms across 8 harmonized cohorts and contrasted the findings with diagnosed ADHD in a population-based register-linkage study. Preterm-born adults may not self-report increased ADHD symptoms. However, they have a higher risk of ADHD diagnosis, warranting preventive strategies and interventions to reduce the presentation of more severe ADHD symptomatology in adulthood.
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Affiliation(s)
| | | | - Anna Pulakka
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Kati Heinonen
- University of Helsinki, Helsinki, Finland
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | | | - Marius Lahti-Pulkkinen
- University of Helsinki, Helsinki, Finland
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Petteri Hovi
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | | | - Peter Bartmann
- Department of Neonatology, University of Bonn, Bonn, Germany
| | - Aulikki Lano
- University of Helsinki, Helsinki, Finland
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Lex W Doyle
- Royal Women's Hospital, Melbourne, VIC, Australia
- University of Melbourne, Melbourne, VIC, Australia
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Peter J Anderson
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
| | - Jeanie L Y Cheong
- Royal Women's Hospital, Melbourne, VIC, Australia
- University of Melbourne, Melbourne, VIC, Australia
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Brian A Darlow
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
| | | | - L John Horwood
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
| | - Marit S Indredavik
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kari Anne I Evensen
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway
| | | | | | - Marina Goulart de Mendonca
- University of Warwick, Coventry, UK
- Department of Neuroscience, Psychology and Behaviour, School of Psychology, University of Leicester, Leicester, UK
| | - Eero Kajantie
- University of Helsinki, Helsinki, Finland
- Finnish Institute for Health and Welfare, Helsinki, Finland
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- PEDEGO Research Unit, MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
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24
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Vittner D, D'Agata A, Choi BY, McGrath J. Release of Oxytocin and Cortisol Is Associated With Neurobehavioral Patterns in Premature Infants. J Obstet Gynecol Neonatal Nurs 2023; 52:248-256. [PMID: 36965512 DOI: 10.1016/j.jogn.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 03/05/2023] [Accepted: 03/06/2023] [Indexed: 03/27/2023] Open
Abstract
OBJECTIVE To examine relationships among salivary oxytocin and cortisol levels in parents and preterm infants and neurobehavioral functioning in preterm infants after skin-to-skin contact. DESIGN A secondary analysis of a randomized crossover study. SETTING NICU. PARTICIPANTS Twenty-eight stable premature infants and their mothers and fathers. METHODS Participating infants contributed 108 saliva samples that we collected 45 minutes after skin-to-skin contact and tested for oxytocin and cortisol. We randomized data collection by whether the infant was held first by the mother or by the father. We conducted linear regression to test if summary scores on the NICU Network Neurobehavioral Scale were associated with salivary oxytocin and cortisol levels. RESULTS We found a significant negative relationship between infant oxytocin levels and the Stress scores (b = -0.07, p < .01) and the Excitability scores (b = -1.12, p = .04) among infants held skin-to-skin with their mothers. We found a significant positive relationship between infant oxytocin levels and the Self-Regulatory scores (b = 0.38, p = .05) among infants held skin-to-skin with their mothers. We found a significant positive relationship between infant cortisol level and the Stress scores (b = 0.05, p = .04), Excitability scores (b = 1.06, p = 0.05), and Asymmetrical Reflexes scores (b = 1.21, p = .03) among infants held skin-to-skin with their mothers. We only found a negative significant relationship between infant cortisol levels and the Stress scores (b = -0.03, p = .04) among infants held skin-to-skin with their fathers. CONCLUSION We found that oxytocin is an important biomarker that may improve infant neurobehavioral functioning. The data showed a difference in oxytocin responses after skin-to-skin contact with mothers compared to fathers.
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25
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Lowe J, Fuller JF, Dempsey AG, Do B, Bann CM, Das A, Gustafson KE, Vohr BR, Hintz SR, Watterberg KL. Cortisol awakening response and developmental outcomes at 6-7 years in children born extremely preterm. Pediatr Res 2023; 93:689-695. [PMID: 35715492 PMCID: PMC9758271 DOI: 10.1038/s41390-022-02113-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 03/17/2022] [Accepted: 05/07/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Extremely preterm (EPT) birth has been related to dysregulation of stress responses and behavioral/learning problems at school age. Early adverse experiences can blunt HPA axis reactivity. We hypothesized that an attenuated cortisol awakening response would be associated with developmental and behavioral problems at school age in EPT children. METHODS This secondary analysis of a sub-cohort of the SUPPORT study included children born between 24 and 27 weeks, evaluated at 6-7 years with a neurodevelopmental battery and cortisol measures. Differences were tested between EPT and a term-born group. Relationships of cortisol awakening response to test scores were analyzed. RESULTS Cortisol was measured in 110 EPT and 29 term-born 6-7 year olds. Unadjusted WISC-IV and NEPSY-II scores were significantly worse among EPT children only. Conners Parent Rating Scale behavior scores were significantly worse among EPT children. After adjusting for covariates, blunted cortisol awakening responses were found to be associated with poorer scores on memory tests and greater problems with inattention for the EPT group (p < 0.05) only. CONCLUSIONS Among children born EPT, we identified an association of blunted cortisol awakening response with memory and inattention problems. This may have implications related to stress reactivity and its relationship to learning problems in children born EPT. CLINICALTRIALS GOV ID Extended Follow-up at School Age for the SUPPORT Neuroimaging and Neurodevelopmental Outcomes (NEURO) Cohort: NCT00233324. IMPACT In children born EPT, stress reactivity may have a relationship to learning problems. Cortisol awakening response should be a component for follow-up in EPT born children. Components of executive function, such as memory and attention, are related to stress reactivity.
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Affiliation(s)
- Jean Lowe
- Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Janell F Fuller
- Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, NM, USA.
| | - Allison G Dempsey
- Department of Pediatrics, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Barbara Do
- Social, Statistical and Environmental Sciences Unit, RTI International, Research Triangle Park, NC, USA
| | - Carla M Bann
- Social, Statistical and Environmental Sciences Unit, RTI International, Research Triangle Park, NC, USA
| | - Abhik Das
- Social, Statistical and Environmental Sciences Unit, RTI International, Rockville, MD, USA
| | | | - Betty R Vohr
- Department of Pediatrics, Women & Infants Hospital, Brown University, Providence, RI, USA
| | - Susan R Hintz
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, USA
| | - Kristi L Watterberg
- Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
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26
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Litt JS, Johnson S, Marlow N, Tiemeier H. Impaired pulmonary function mediates inattention in young adults born extremely preterm. Acta Paediatr 2023; 112:254-260. [PMID: 36330674 DOI: 10.1111/apa.16586] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/17/2022] [Accepted: 11/03/2022] [Indexed: 11/06/2022]
Abstract
AIM To test whether poor childhood pulmonary function explains the relationship between extremely preterm (EP) birth and attention-deficit/hyperactivity disorder (ADHD) symptoms in young adulthood. METHODS EPICure birth cohort participants include children born <26 weeks' gestation in the United Kingdom and Ireland in 1995 and their term-born classmates. Predictor was EP birth. Outcomes were inattention/hyperactivity subscale z-scores at 19 years. Forced expiratory volume (FEV1) z-scores in childhood and young adulthood were mediators. We used recursive path analysis to determine the direct effect of EP birth on inattention/hyperactivity and its indirect effect through pulmonary function. RESULTS Ninety EP and 47 term-born participants had pulmonary function testing at 11 and 19 years. Inattention z-scores were higher in the EP group (mean difference 0.55 [95% CI 0.11, 0.99]) but not hyperactivity. Compared to term-born peers, EP participants had lower FEV1 z-scores at 11 (mean difference-1.35 [95% CI -1.72, -0.98]) and 19 (mean difference-1.29 [95% CI -1.65, -0.92]). Path models revealed that childhood pulmonary function explained the relationship between EP birth and inattention. CONCLUSIONS Extremely preterm young adults have increased risk for inattention compared to term-born peers. Poor pulmonary function appears to underlie this risk. The mechanisms responsible remain unclear and warrant further study.
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Affiliation(s)
- Jonathan S Litt
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Division of Newborn Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Samantha Johnson
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Neil Marlow
- UCL Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - Henning Tiemeier
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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27
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Manigault AW, Sheinkopf SJ, Carter BS, Check J, Helderman J, Hofheimer JA, McGowan EC, Neal CR, O’Shea M, Pastyrnak S, Smith LM, Everson TM, Marsit CJ, Dansereau LM, DellaGrotta SA, Lester BM. Acoustic Cry Characteristics in Preterm Infants and Developmental and Behavioral Outcomes at 2 Years of Age. JAMA Netw Open 2023; 6:e2254151. [PMID: 36723941 PMCID: PMC9892956 DOI: 10.1001/jamanetworkopen.2022.54151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
IMPORTANCE Acoustic cry characteristics have been associated with severe medical problems in newborns. However, little is known about the utility of neonatal acoustic cry characteristics in the prediction of long-term outcomes of very preterm infants. OBJECTIVES To evaluate whether acoustic characteristics of infant cry at neonatal intensive care unit (NICU) discharge are associated with behavioral and developmental outcomes at age 2 years in infants born very preterm. DESIGN, SETTING, AND PARTICIPANTS Infants born less than 30 weeks postmenstrual age (PMA) were enrolled from April 2014 through June 2016 as part of a multicenter (9 US university affiliated NICUs) cohort study and followed to adjusted age 2 years. Reported analyses began on September 2021. Data were analyzed from September 2021 to September 2022. EXPOSURES The primary exposure was premature birth (<30 weeks PMA). MAIN OUTCOMES AND MEASURES Cries were recorded during a neurobehavioral examination administered during the week of NICU discharge. Cry episodes were analyzed using a previously published computerized system to characterize cry acoustics. Year-2 outcomes included the Bayley-III Composite scores, Child Behavior Checklist (CBCL) and the Modified Checklist for Autism in Toddlers (M-CHAT R/F), dichotomized using clinically significant cutoffs (<85 on Bayley Language, Cognitive and/or Motor Composite scores, T-score >63 on the CBCL Internalizing, Externalizing and/or Total Problem Scales and total M-CHAT R/F score >2). RESULTS Analyzed infants (363 participants) were primarily male (202 participants [55.65%]) and had a mean [SD] gestational age of 27.08 [1.95] weeks). Cross-validated random forest models revealed that cry acoustics were associated with 2-year outcomes. Tests of diagnostic odds ratios (DOR) revealed that infants who exhibited total problem behavior CBCL scores greater than 63 at age 2 years were 3.3 times more likely (95% CI, 1.44-7.49) to be identified as so by random forest model estimates relative to other infants (scores ≤63); this association was robust to adjustment for family-wise type-I error rates and covariate measures. Similar associations were observed for internalizing (DOR, 2.39; 95% CI, 1.04-5.47) and externalizing (DOR, 2.25; 95% CI, 1.12-4.54) scores on the CBCL, clinically significant language (DOR, 1.71; 95% CI, 1.10-2.67) and cognitive (DOR, 1.70; 95% CI, 1.00-2.88) scores on the Bayley-III, and a positive autism screen on the M-CHAT (DOR, 1.91; 95% CI, 1.05-3.44). CONCLUSIONS AND RELEVANCE In this cohort study of preterm infants, findings pointed to the potential use of acoustic cry characteristics in the early identification of risk for long-term developmental and behavioral deficits.
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Affiliation(s)
- Andrew W. Manigault
- Brown Center for the Study of Children at Risk, Women and Infants Hospital of Rhode Island, Providence
| | - Stephen J. Sheinkopf
- Thompson Center for Autism and Neurodevelopmental Disorders, University of Missouri, Columbia
| | | | - Jennifer Check
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | | | - Julie A. Hofheimer
- University of North Carolina Chapel Hill School of Medicine, Chapel Hill
| | - Elisabeth C. McGowan
- Departments of Psychiatry and Pediatrics, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Charles R. Neal
- University of Hawaii John A Burns School of Medicine, Honolulu, Hawaii
| | - Michael O’Shea
- University of North Carolina Chapel Hill School of Medicine, Chapel Hill
| | | | - Lynne M. Smith
- Harbor-University of California, Los Angeles Medical Center, Torrance
| | - Todd M. Everson
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Carmen J. Marsit
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Lynne M. Dansereau
- Brown Center for the Study of Children at Risk, Women and Infants Hospital of Rhode Island, Providence
| | - Sheri A. DellaGrotta
- Brown Center for the Study of Children at Risk, Women and Infants Hospital of Rhode Island, Providence
| | - Barry M. Lester
- Brown Center for the Study of Children at Risk, Women and Infants Hospital of Rhode Island, Providence
- Departments of Psychiatry and Pediatrics, Alpert Medical School of Brown University, Providence, Rhode Island
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Ekblad MO, Ngum P, Merisaari H, Saunavaara V, Parkkola R, Setänen S. Maternal smoking during pregnancy negatively affects brain volumes proportional to intracranial volume in adolescents born very preterm. Front Hum Neurosci 2023; 16:1085986. [PMID: 36684830 PMCID: PMC9849910 DOI: 10.3389/fnhum.2022.1085986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/14/2022] [Indexed: 01/07/2023] Open
Abstract
Background Maternal smoking during pregnancy has been shown to associate with smaller frontal lobe and cerebellar volumes in brain magnetic resonance imaging (MRI) at term age in very preterm infants. The aim of this study was to examine the effect of maternal smoking during pregnancy on volumetric brain MRI findings at 13 years. We hypothesized that adverse effects of smoking during pregnancy on brain volumes are still seen during adolescence. Methods Included adolescents were born very preterm (gestational age < 32 weeks and/or birth weight ≤ 1,500 g) between April 2004 and December 2006 at the Turku University Hospital, Finland. Information on maternal smoking status (yes or no) during pregnancy was collected from medical records and maternal questionnaires before discharge. Adolescents underwent volumetric brain MRI at 13 years of age. Image post-processing was performed with FreeSurfer. Regional volumes, cortical thickness, surface area, and curvature were computed from 33 cortical regions of interest (ROIs). Additionally, volumes were calculated for 18 subcortical regions, as well as for white matter, gray matter, and intracranial volume. We normalized quantified absolute volumes for head size by dividing volumes with corresponding intracranial volumes. false discovery rate (FDR) correction for multiple comparisons across regions was used. Results A total of 9/44 (21%) adolescents had been exposed to maternal smoking during pregnancy. No statistically significant differences in absolute volumes were observed between the groups (p > 0.05). Regarding volumes proportional to intracranial volume, the adolescents in the exposed group exhibited smaller gray matter volumes in the inferotemporal (FDR corrected p = 0.022) and parahippocampal (p = 0.018) regions compared to the unexposed group. The surface area in the exposed group was also smaller in the parahippocampal (p = 0.046) and postcentral (p = 0.046) regions compared to the unexposed group. No statistically significant differences after correction for multiple comparisons were found for either curvature or cortical thickness between the groups. Conclusion Maternal smoking exposure during pregnancy may have long-term effects on brain volumes up to 13 years in adolescents born very preterm. Our findings emphasize the importance of smoking-free pregnancy.
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Affiliation(s)
- Mikael O. Ekblad
- Department of General Practice, Institute of Clinical Medicine, University of Turku and Turku University Hospital, Turku, Finland,*Correspondence: Mikael O. Ekblad,
| | - Peter Ngum
- Turku Brain Injury Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Harri Merisaari
- Department of Radiology, University of Turku, Turku, Finland,Turku Brain and Mind Center, University of Turku, Turku, Finland
| | - Virva Saunavaara
- Division of Medical Imaging, Department of Medical Physics, Turku University Hospital, Turku, Finland,Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
| | - Riitta Parkkola
- Department of Radiology, University of Turku, Turku, Finland,Department of Radiology, Turku University Hospital, Turku, Finland
| | - Sirkku Setänen
- Department of Pediatric Neurology, University of Turku and Turku University Hospital, Turku, Finland
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29
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Morales MF, MacBeth A, Swartzman S, Girard LC. Multi-Trajectories of Conduct Problems, Hyperactivity/Inattention, and Peer Problems Across Childhood: Results from the Growing Up in Scotland Birth Cohort. Res Child Adolesc Psychopathol 2023. [PMID: 35920956 DOI: 10.1007/s10802-022-00956-8/tables/5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
Using a person-centred approach, this study inspected multi-trajectories of conduct problems, hyperactivity/inattention and peer problems, and associated risk factors for group membership. The sample included 3,578 children (50.8% males) from a population birth cohort in Scotland (Growing Up in Scotland). The parental version of the Strengths and Difficulties Questionnaire (SDQ) was used when children were 4, 5, 6, 7, and 10 years old. Antecedent factors at the perinatal, child, and family levels were collected using parental reports, observation, and standardised assessments at 10, 24, and 36 months. A group-based multi-trajectory analysis was employed. Findings showed that a six-group model best fit the data. Identified groups included non-engagers, normative, decreasing externalising/low peer problems, low externalising/moderate peer problems, moderate externalising/increasing peer problems and multimorbid moderate-high chronic. Findings suggest multimorbidity between externalising behaviours and peer problems in the more elevated groups. Two common protective factors emerged across all groups: caregiver mental health and parent-infant attachment. Identified risk factors were specific to group membership. Risk factors for the most elevated group included single-parent status, social deprivation, previous neonatal intensive care unit admission, child sex, whilst children's expressive language was a protective factor. Taken together, findings contribute to the emerging literature modelling trajectories of externalising behaviours and peer problems simultaneously and have important practical implications for prevention of problems in childhood, by identifying targets at the perinatal, child, and family levels.
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Affiliation(s)
- María Francisca Morales
- Department of Clinical Psychology, School of Health in Social Science, The University of Edinburgh, Medical School (Doorway 6), Teviot Place, Edinburgh, EH8 9AG, UK.
| | - Angus MacBeth
- Department of Clinical Psychology, School of Health in Social Science, The University of Edinburgh, Medical School (Doorway 6), Teviot Place, Edinburgh, EH8 9AG, UK
| | - Samantha Swartzman
- Department of Clinical Psychology, School of Health in Social Science, The University of Edinburgh, Medical School (Doorway 6), Teviot Place, Edinburgh, EH8 9AG, UK
| | - Lisa-Christine Girard
- Department of Clinical Psychology, School of Health in Social Science, The University of Edinburgh, Medical School (Doorway 6), Teviot Place, Edinburgh, EH8 9AG, UK
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Multi-Trajectories of Conduct Problems, Hyperactivity/Inattention, and Peer Problems Across Childhood: Results from the Growing Up in Scotland Birth Cohort. Res Child Adolesc Psychopathol 2023; 51:55-69. [PMID: 35920956 PMCID: PMC9763152 DOI: 10.1007/s10802-022-00956-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2022] [Indexed: 10/16/2022]
Abstract
Using a person-centred approach, this study inspected multi-trajectories of conduct problems, hyperactivity/inattention and peer problems, and associated risk factors for group membership. The sample included 3,578 children (50.8% males) from a population birth cohort in Scotland (Growing Up in Scotland). The parental version of the Strengths and Difficulties Questionnaire (SDQ) was used when children were 4, 5, 6, 7, and 10 years old. Antecedent factors at the perinatal, child, and family levels were collected using parental reports, observation, and standardised assessments at 10, 24, and 36 months. A group-based multi-trajectory analysis was employed. Findings showed that a six-group model best fit the data. Identified groups included non-engagers, normative, decreasing externalising/low peer problems, low externalising/moderate peer problems, moderate externalising/increasing peer problems and multimorbid moderate-high chronic. Findings suggest multimorbidity between externalising behaviours and peer problems in the more elevated groups. Two common protective factors emerged across all groups: caregiver mental health and parent-infant attachment. Identified risk factors were specific to group membership. Risk factors for the most elevated group included single-parent status, social deprivation, previous neonatal intensive care unit admission, child sex, whilst children's expressive language was a protective factor. Taken together, findings contribute to the emerging literature modelling trajectories of externalising behaviours and peer problems simultaneously and have important practical implications for prevention of problems in childhood, by identifying targets at the perinatal, child, and family levels.
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31
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DeMauro SB, Merhar SL, Peralta-Carcelen M, Vohr BR, Duncan AF, Hintz SR. The critical importance of follow-up to school age: Contributions of the NICHD Neonatal Research Network. Semin Perinatol 2022; 46:151643. [PMID: 35850744 PMCID: PMC10983779 DOI: 10.1016/j.semperi.2022.151643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Follow-up studies are essential for understanding outcomes and informing the care of infants with high risk for medical and developmental consequences because of extreme prematurity or perinatal illness. Studies that extend to school age often identify sequelae that go unrecognized in neonatal or short-term follow-up studies. Many critical neurocognitive, behavioral, functional, and health outcomes are best assessed beginning at school age. The Eunice Kennedy Shriver National Institute of Child Health and Development Neonatal Research Network (NRN) has performed comprehensive school age evaluations of several key trial cohorts. This manuscript summarizes the important contributions of school age follow-up studies in the NRN, both historically and in ongoing research. We describe in detail the clinical questions that have been answered by the completed studies and new questions about the outcomes of high-risk infants that must be addressed by ongoing and future studies.
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Affiliation(s)
- Sara B DeMauro
- University of Pennsylvania Perelman School of Medicine and Children's Hospital of Philadelphia, 2716 South Street, Philadelphia, Pennsylvania 19146, United States.
| | - Stephanie L Merhar
- University of Cincinnati and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
| | | | - Betty R Vohr
- Warren Alpert Medical School of Brown University and Women & Infants Hospital of Rhode Island, Providence, Rhode Island, United States
| | - Andrea F Duncan
- University of Pennsylvania Perelman School of Medicine and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
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Ralph KMI, Bull K, Trotter C, Wood S, Jones CE. Paediatric health-related quality of life in congenital cytomegalovirus. Arch Dis Child 2022; 107:1004-1011. [PMID: 35768174 DOI: 10.1136/archdischild-2022-324007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 06/10/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Congenital cytomegalovirus (cCMV) is the most common congenital infection globally. This cross-sectional study aimed to describe the health-related quality of life (HRQoL) of children with cCMV and that of their parents. METHODS Families of children with cCMV in the UK were approached through the charity CMV Action. Parents completed questionnaires about their own HRQoL and that of their child. Children who were able to self-report completed questionnaires about their own HRQoL. Demographic characteristics of the sample were described using descriptive statistics. Questionnaire responses were scored, and domain and summary scores were calculated and compared with UK population norms, where available. RESULTS Seventy families participated, with children aged between 5 months and 18 years. Children with cCMV had poorer HRQoL compared with children from UK population data. HRQoL of children whose health was more severely affected by cCMV was poorer than that of children whose health was less severely affected. Parents of children whose health was moderately or severely affected had greater psychological morbidity and poorer HRQoL in physical, emotional, social, and cognitive functioning domains than parents of less severely affected children. CONCLUSIONS cCMV has a significant effect on the HRQoL of children with cCMV and their parents, with the children with the most significant health needs having the lowest HRQoL compared with those children with little or no effects on their health. This data could contribute to health economic analyses, informing resource allocation to potential interventions for the prevention and treatment of cCMV.
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Affiliation(s)
| | - Kim Bull
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Caroline Trotter
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | | | - Christine E Jones
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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McLean MA, Scoten OC, Chau CMY, Synnes A, Miller SP, Grunau RE. Association of Neonatal Pain-Related Stress and Parent Interaction With Internalizing Behaviors Across 1.5, 3.0, 4.5, and 8.0 Years in Children Born Very Preterm. JAMA Netw Open 2022; 5:e2238088. [PMID: 36269352 PMCID: PMC9587482 DOI: 10.1001/jamanetworkopen.2022.38088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
IMPORTANCE Internalizing (anxiety and/or depressive) behaviors are prevalent in children born very preterm (24-32 weeks' gestation). Procedural pain-related stress in the neonatal intensive care unit (NICU) is associated with long-term internalizing problems in this population; however, whether positive parenting during toddlerhood attenuates development of internalizing behaviors across childhood is unknown. OBJECTIVE To investigate whether neonatal pain-related stress is associated with trajectories of internalizing behaviors across 1.5, 3.0, 4.5, and 8.0 years, and whether supportive parenting behaviors and lower parenting stress at 1.5 and 3.0 years attenuate this association. DESIGN, SETTING, AND PARTICIPANTS In this prospective longitudinal cohort study, preterm neonates (born at 24-32 weeks' gestation) were recruited from August 16, 2006, to September 9, 2013, with follow-up visits at ages 1.5, 3.0, 4.5, and 8.0 years. The study was conducted at BC Women's Hospital, Vancouver, Canada, with recruitment from a level III neonatal intensive care unit and sequential developmental assessments performed in a Neonatal Follow-up Program. Data analysis was performed from August to December 2021. MAIN OUTCOMES AND MEASURES Parental report of child internalizing behaviors on the Child Behavior Checklist at 1.5, 3.0, 4.5, and 8.0 years. RESULTS A total of 234 neonates were recruited, and 186 children (101 boys [54%]) were included in the current study across ages 1.5 (159 children), 3.0 (169 children), 4.5 (162 children), and 8.0 (153 children) years. After accounting for clinical factors associated with prematurity, greater neonatal pain-related stress was associated with more internalizing behaviors across ages (B = 4.95; 95% CI, 0.76 to 9.14). Higher parenting stress at age 1.5 years (B = 0.17; 95% CI, 0.11 to 0.23) and a less supportive parent environment (less sensitivity, structure, nonintrusiveness, nonhostility, and higher parenting stress; B = -5.47; 95% CI, -9.44 to -1.51) at 3.0 years were associated with greater internalizing problems across development to age 8.0 years. CONCLUSIONS AND RELEVANCE In this cohort study of children born very preterm, exposure to repetitive neonatal pain-related stress was associated with persistent internalizing behavior problems across toddlerhood to age 8.0 years. Supportive parenting behaviors during early childhood were associated with better long-term behavioral outcomes, whereas elevated parenting stress was associated with more child anxiety and/or depressive behaviors in this population. These findings reinforce the need to prevent pain in preterm neonates and inform future development of targeted parent-led behavioral interventions.
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Affiliation(s)
- Mia A. McLean
- BC Children’s Hospital Research Institute, Vancouver, British Columbia, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Olivia C. Scoten
- BC Children’s Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Cecil M. Y. Chau
- BC Children’s Hospital Research Institute, Vancouver, British Columbia, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anne Synnes
- BC Children’s Hospital Research Institute, Vancouver, British Columbia, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
- BC Women’s Hospital, Vancouver, British Columbia, Canada
| | - Steven P. Miller
- Department of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Ruth E. Grunau
- BC Children’s Hospital Research Institute, Vancouver, British Columbia, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
- BC Women’s Hospital, Vancouver, British Columbia, Canada
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van Beek PE, Rijken M, Broeders L, ter Horst HJ, Koopman-Esseboom C, de Kort E, Laarman C, Mulder-de Tollenaer SM, Steiner K, Swarte RMC, van Westering-Kroon E, Oei SG, Leemhuis AG, Andriessen P. Two-year neurodevelopmental outcome in children born extremely preterm: the EPI-DAF study. Arch Dis Child Fetal Neonatal Ed 2022; 107:467-474. [PMID: 35236745 PMCID: PMC9411912 DOI: 10.1136/archdischild-2021-323124] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 01/29/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE In 2010, the Dutch practice regarding initiation of active treatment in extremely preterm infants was lowered from 25 completed weeks' to 24 completed weeks' gestation. The nationwide Extremely Preterm Infants - Dutch Analysis on Follow-up Study was set up to provide up-to-date data on neurodevelopmental outcome at 2 years' corrected age (CA) after this guideline change. Design: National cohort study. PATIENTS All live born infants between 240/7 weeks' and 266/7 weeks' gestational age who were 2 years' CA in 2018-2020. MAIN OUTCOME MEASURE Impairment at 2 years' CA, based on cognitive score (Bayley-III-NL), neurological examination and neurosensory function. RESULTS 651 of 991 live born infants (66%) survived to 2 years' CA, with data available for 554 (85%). Overall, 62% had no impairment, 29% mild impairment and 9% moderate-to-severe impairment (further defined as neurodevelopmental impairment, NDI). The percentage of survivors with NDI was comparable for infants born at 24 weeks', 25 weeks' and 26 weeks' gestation. After multivariable analysis, severe brain injury and low maternal education were associated with higher odds on NDI. NDI-free survival was 48%, 67% and 75% in neonatal intensive care unit (NICU)-admitted infants at 24, 25 and 26 weeks' gestation, respectively. CONCLUSIONS Lowering the threshold has not been accompanied by a large increase in moderate-to-severely impaired infants. Among live-born and NICU-admitted infants, an increase in NDI-free survival was observed from 24 weeks' to 26 weeks' gestation. This description of a national cohort with high follow-up rates gives an accurate description of the range of outcomes that may occur after extremely preterm birth.
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Affiliation(s)
- Pauline E van Beek
- Department of Neonatology, Máxima Medical Center, Veldhoven, Noord-Brabant, The Netherlands
| | - Monique Rijken
- Department of Neonatology, Willem-Alexander Children’s Hospital, Leiden University Medical Center, Leiden, The Netherlands
| | - Lisa Broeders
- The Netherlands Perinatal Registry, Utrecht, The Netherlands
| | - Hendrik J ter Horst
- Department of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Corine Koopman-Esseboom
- Department of Neonatology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ellen de Kort
- Department of Neonatology, Máxima Medical Center, Veldhoven, Noord-Brabant, The Netherlands
| | - Céleste Laarman
- Department of Neonatology, VU University Medical Center, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | | | - Katerina Steiner
- Department of Perinatology, Amalia Children’s Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Renate MC Swarte
- Department of Neonatology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | | | - S Guid Oei
- Department of Obstetrics and Gynaecology, Máxima Medical Center, Veldhoven, The Netherlands,Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Aleid G Leemhuis
- Department of Neonatology, Emma Children’s Hospital, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Peter Andriessen
- Department of Neonatology, Máxima Medical Center, Veldhoven, The Netherlands,Department of Applied Physics, School of Medical Physics and Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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Gestational age at birth and academic attainment in primary and secondary school in England: Evidence from a national cohort study. PLoS One 2022; 17:e0271952. [PMID: 35976808 PMCID: PMC9385000 DOI: 10.1371/journal.pone.0271952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 07/11/2022] [Indexed: 11/25/2022] Open
Abstract
Preterm birth (<37 weeks’ gestation) is a risk factor for poor educational outcomes. A dose-response effect of earlier gestational age at birth on poor primary school attainment has been observed, but evidence for secondary school attainment is limited and focused predominantly on the very preterm (<32 weeks) population. We examined the association between gestational age at birth and academic attainment at the end of primary and secondary schooling in England. Data for children born in England from 2000–2001 were drawn from the population-based UK Millennium Cohort Study. Information about the child’s birth, sociodemographic factors and health was collected from parents. Attainment on national tests at the end of primary (age 11) and secondary school (age 16) was derived from linked education records. Data on attainment in primary school was available for 6,950 pupils and that of secondary school was available for 7,131 pupils. Adjusted relative risks (aRRs) for these outcomes were estimated at each stage separately using modified Poisson regression. At the end of primary school, 17.7% of children had not achieved the expected level in both English and Mathematics and this proportion increased with increasing prematurity. Compared to full term (39–41 weeks) children, the strongest associations were among children born moderately (32–33 weeks; aRR = 2.13 (95% CI 1.44–3.13)) and very preterm (aRR = 2.06 (95% CI 1.46–2.92)). Children born late preterm (34–36 weeks) and early term (37–38 weeks) were also at higher risk with aRR = 1.18 (95% CI 0.94–1.49) and aRR = 1.21 (95% CI 1.05–1.38), respectively. At the end of secondary school, 45.2% had not passed at least five General Certificate of Secondary Education examinations including English and Mathematics. Following adjustment, only children born very preterm were at significantly higher risk (aRR = 1.26 (95% CI 1.03–1.54)). All children born before full term are at risk of poorer attainment during primary school compared with term-born children, but only children born very preterm remain at risk at the end of secondary schooling. Children born very preterm may require additional educational support throughout compulsory schooling.
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McGowan EC, Hofheimer JA, O’Shea TM, Kilbride H, Carter BS, Check J, Helderman J, Neal CR, Pastyrnak S, Smith LM, Camerota M, Dansereau LM, Della Grotta SA, Lester BM. Analysis of Neonatal Neurobehavior and Developmental Outcomes Among Preterm Infants. JAMA Netw Open 2022; 5:e2222249. [PMID: 35849396 PMCID: PMC9294999 DOI: 10.1001/jamanetworkopen.2022.22249] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE The ability to identify poor outcomes and treatable risk factors among very preterm infants remains challenging; improving early risk detection and intervention targets to potentially address developmental and behavioral delays is needed. OBJECTIVE To determine associations between neonatal neurobehavior using the Neonatal Intensive Care Unit (NICU) Network Neurobehavioral Scale (NNNS), neonatal medical risk, and 2-year outcomes. DESIGN, SETTING, AND PARTICIPANTS This multicenter cohort enrolled infants born at less than 30 weeks' gestation at 9 US university-affiliated NICUs. Enrollment was conducted from April 2014 to June 2016 with 2-year adjusted age follow-up assessment. Data were analyzed from December 2019 to January 2022. EXPOSURES Adverse medical and psychosocial conditions; neurobehavior. MAIN OUTCOMES AND MEASURES Bayley Scales of Infant and Toddler Development, third edition (Bayley-III), cognitive, language, and motor scores of less than 85 and Child Behavior Checklist (CBCL) T scores greater than 63. NNNS examinations were completed the week of NICU discharge, and 6 profiles of neurobehavior were identified by latent profile analysis. Generalized estimating equations tested associations among NNNS profiles, neonatal medical risk, and 2-year outcomes while adjusting for site, maternal socioeconomic and demographic factors, maternal psychopathology, and infant sex. RESULTS A total of 679 enrolled infants had medical and NNNS data; 2-year follow-up data were available for 479 mothers and 556 infants (mean [SD] postmenstrual age at birth, 27.0 [1.9] weeks; 255 [45.9%] female). Overall, 268 mothers (55.9%) were of minority race and ethnicity, and 127 (26.6%) lived in single-parent households. The most common neonatal medical morbidity was BPD (287 [51.7%]). Two NNNS behavior profiles, including 157 infants, were considered high behavioral risk. Infants with at least 2 medical morbidities (n = 123) were considered high medical risk. Infants with high behavioral and high medical risk were 4 times more likely to have Bayley-III motor scores less than 85 compared with those with low behavioral and low medical risk (adjusted relative risk [aRR], 4.1; 95% CI, 2.9-5.1). Infants with high behavioral and high medical risk also had increased risk for cognitive scores less than 85 (aRR, 2.7; 95% CI, 1.8-3.4). Only infants with high behavioral and low medical risk were in the clinical range for CBCL internalizing and total problem scores (internalizing: aRR, 2.3; 95% CI, 1.1-4.5; total: aRR, 2.5; 95% CI, 1.2-4.4). CONCLUSIONS AND RELEVANCE In this study, high-risk neonatal neurobehavioral patterns at NICU discharge were associated with adverse cognitive, motor, and behavioral outcomes at 2 years. Used in conjunction with medical risk, neonatal neurobehavioral assessments could enhance identification of infants at highest risk for delay and offer opportunities to provide early, targeted therapies.
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Affiliation(s)
- Elisabeth C. McGowan
- Department of Pediatrics, Brown Alpert Medical School and Women and Infants Hospital, Providence, Rhode Island
| | - Julie A. Hofheimer
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill
| | - T. Michael O’Shea
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill
| | - Howard Kilbride
- Department of Pediatrics-Neonatology, Children’s Mercy Hospital, Kansas City, Missouri
| | - Brian S. Carter
- Department of Pediatrics-Neonatology, Children’s Mercy Hospital, Kansas City, Missouri
| | - Jennifer Check
- Department of Pediatrics, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Jennifer Helderman
- Department of Pediatrics, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Charles R. Neal
- Department of Pediatrics, University of Hawaii John A. Burns School of Medicine, Honolulu
| | - Steve Pastyrnak
- Department of Pediatrics, Spectrum Health–Helen DeVos Hospital, Grand Rapids, Michigan
| | - Lynne M. Smith
- Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, California
| | - Marie Camerota
- Brown Center for the Study of Children at Risk, Brown Alpert Medical School and Women and Infants Hospital, Providence, Rhode Island
| | - Lynne M. Dansereau
- Brown Center for the Study of Children at Risk, Brown Alpert Medical School and Women and Infants Hospital, Providence, Rhode Island
| | - Sheri A. Della Grotta
- Brown Center for the Study of Children at Risk, Brown Alpert Medical School and Women and Infants Hospital, Providence, Rhode Island
| | - Barry M. Lester
- Department of Psychiatry and Human Behavior, Brown Alpert Medical School, Providence, Rhode Island
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Frazier JA, Cochran D, Kim S, Jalnapurkar I, Joseph RM, Hooper SR, Santos HP, Ru H, Venuti L, Singh R, Washburn LK, Gogcu S, Msall ME, Kuban KCK, Rollins JV, Hanson SG, Jara H, Pastyrnak SL, Roell KR, Fry RC, O'Shea TM. Psychiatric Outcomes, Functioning, and Participation in Extremely Low Gestational Age Newborns at Age 15 Years. J Am Acad Child Adolesc Psychiatry 2022; 61:892-904.e2. [PMID: 34973366 PMCID: PMC9240104 DOI: 10.1016/j.jaac.2021.12.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 10/13/2021] [Accepted: 12/22/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To evaluate the prevalence, co-occurrence, sex differences, and functional correlates of DSM-5 psychiatric disorders in 15-year-old adolescents born extremely preterm. METHOD The Extremely Low Gestational Age Newborns (ELGAN) Study is a longitudinal study of children born <28 weeks gestation. At age 15, 670 adolescents completed the Mini-International Neuropsychiatric Interview for Children and Adolescents (MINI-KID), the Youth Self-Report, a disability scale of participation in social roles, and cognitive testing. Parents completed a family psychiatric history questionnaire. RESULTS The most prevalent psychiatric disorders were anxiety, attention-deficit/hyperactivity disorder, and major depression. More girls met criteria for anxiety than boys. Though 66% of participants did not meet criteria for a psychiatric disorder, 15% met criteria for 1, 9% for 2, and 8% for ≥3 psychiatric disorders. Participants with ≥2 psychiatric disorders were more likely to have repeated a grade, to have an individualized educational program, and to have a lower nonverbal IQ than those with no psychiatric disorders. Participants with any psychiatric disorder were more likely to use psychotropic medications; to have greater cognitive and functional impairment; and to have mothers who were single, were on public health insurance, and had less than a high school education. Finally, a positive family psychiatric history was identified more frequently among adolescents with ≥3 psychiatric disorders. CONCLUSION Among adolescents born extremely preterm, anxiety, major depression, and attention-deficit/hyperactivity disorder were the most prevalent psychiatric disorders at age 15. Adolescents with >1 psychiatric disorder were at increased risk for multiple functional and participatory challenges.
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Affiliation(s)
- Jean A Frazier
- Eunice Kennedy Shriver Center at the University of Massachusetts Medical School, Worcester, Massachusetts.
| | - David Cochran
- Eunice Kennedy Shriver Center at the University of Massachusetts Medical School, Worcester, Massachusetts
| | - Sohye Kim
- Eunice Kennedy Shriver Center at the University of Massachusetts Medical School, Worcester, Massachusetts
| | - Isha Jalnapurkar
- Eunice Kennedy Shriver Center at the University of Massachusetts Medical School, Worcester, Massachusetts
| | | | | | | | - Hongyu Ru
- University of North Carolina at Chapel Hill
| | - Lauren Venuti
- Eunice Kennedy Shriver Center at the University of Massachusetts Medical School, Worcester, Massachusetts
| | | | - Lisa K Washburn
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Semsa Gogcu
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Michael E Msall
- University of Chicago Comer Children's Hospital and JP Kennedy Research Center on Intellectual and Developmental Disabilities, Chicago, Illinois
| | | | | | | | - Hernan Jara
- Boston University School of Medicine, Massachusetts
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Davis R, Donati G, Finnegan K, Boardman JP, Dean B, Fletcher‐Watson S, Forrester GS. Social gaze in preterm infants may act as an early indicator of atypical lateralization. Child Dev 2022; 93:869-880. [PMID: 35112717 PMCID: PMC9545542 DOI: 10.1111/cdev.13734] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 10/25/2021] [Accepted: 11/08/2021] [Indexed: 11/28/2022]
Abstract
Visual field biases have been identified as markers of atypical lateralization in children with developmental conditions, but this is the first investigation to consider early lateralized gaze behaviors for social stimuli in preterm infants. Eye-tracking methods with 51 preterm (33 male, 92.1% White) and 61 term-born (31 male, 90.1% White) infants aged 8-10 months from Edinburgh, UK, captured the development of visual field biases, comparing gaze behavior to social and non-social stimuli on the left versus right of the screen. Preterm infants showed a significantly reduced interest to social stimuli on the left versus right compared to term children (d = .58). Preterm children exhibit early differential orienting preferences that may be an early indicator of atypical lateralized function.
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Affiliation(s)
- Rachael Davis
- Salvesen Mindroom Research CentreUniversity of EdinburghEdinburghUK
| | - Georgina Donati
- Department of Psychological SciencesBirkbeck, University of LondonLondonUK
| | - Kier Finnegan
- Department of ImmunobiologyUCL Great Ormond Street Institute of Child HealthLondonUK
| | - James P. Boardman
- MRC Centre for Reproductive HealthUniversity of EdinburghEdinburghUK
- Centre for Clinical Brain SciencesUniversity of EdinburghEdinburghUK
| | - Bethan Dean
- MRC Centre for Reproductive HealthUniversity of EdinburghEdinburghUK
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Twilhaar ES, Pierrat V, Marchand-Martin L, Benhammou V, Kaminski M, Ancel PY. Profiles of Functioning in 5.5-Year-Old Very Preterm Born Children in France: The EPIPAGE-2 Study. J Am Acad Child Adolesc Psychiatry 2022; 61:881-891. [PMID: 34508804 DOI: 10.1016/j.jaac.2021.09.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 08/05/2021] [Accepted: 09/01/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Very preterm born children are at risk for impairments in multiple neurodevelopmental domains, but outcomes vary between individuals. The present study aimed to distinguish subgroups with distinct profiles of functioning across motor, cognitive, behavioral, and psychosocial domains. These profiles were related to neonatal and social/environmental factors. METHOD The sample included 1977 children born very preterm (<32 weeks' gestation) in 2011 from the French population-based EPIPAGE-2 cohort. Using latent profile analysis, subgroups of children were distinguished based on their functioning at 5.5 years. The relation between outcome profiles and neonatal and social/environmental factors was tested using multivariable multinomial logistic regression analysis. RESULTS Four subgroups with distinct outcome profiles were distinguished: no deficit in any domain (45%); motor and cognitive deficits without behavioral/psychosocial deficits (31%); primarily behavioral and psychosocial deficits (16%); and deficits in multiple domains (8%). Male sex (odds ratio [OR] = 2.1-2.7), bronchopulmonary dysplasia (OR = 2.1-2.8), low parental education level (OR = 1.8-2.1), and parental non-European immigrant status (OR = 2.3-3.0) were independently associated with higher odds for all suboptimal outcome profiles compared to the favorable outcome profile. CONCLUSION Among 5.5-year-old very preterm born children, subgroups can be distinguished with distinct outcome profiles that vary in severity, type, and combinations of deficits. This information is important for the development of interventions that are tailored to the needs of large subgroups of children across multiple domains of functioning. General neonatal and social/environmental factors may be useful for early identification of very preterm born children at risk for general rather than domain-specific impairments.
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Affiliation(s)
- E Sabrina Twilhaar
- Université de Paris, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France.
| | - Véronique Pierrat
- Université de Paris, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France; CHU Lille, Jeanne de Flandre Hospital, Lille, France
| | - Laetitia Marchand-Martin
- Université de Paris, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
| | - Valérie Benhammou
- Université de Paris, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
| | - Monique Kaminski
- Université de Paris, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
| | - Pierre-Yves Ancel
- Université de Paris, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France; Assistance Publique-Hôpitaux de Paris, Clinical Investigation Center P1419, Paris, France
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Klamer A, Toftlund LH, Grimsson K, Halken S, Zachariassen G. IQ Was Not Improved by Post-Discharge Fortification of Breastmilk in Very Preterm Infants. Nutrients 2022; 14:nu14132709. [PMID: 35807888 PMCID: PMC9268839 DOI: 10.3390/nu14132709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/26/2022] [Accepted: 06/28/2022] [Indexed: 02/04/2023] Open
Abstract
(1) Very preterm infants are at increased risk of cognitive deficits, motor impairments, and behavioural problems. Studies have tied insufficient nutrition and growth to an increased risk of neurodevelopmental impairment; (2) Methods: Follow-up study on cognitive and neuropsychological development at 6 years corrected age (CA) in 214 very preterm infants, including 141 breastfed infants randomised to mother’s own milk (MOM) with (F-MOM) or without (U-MOM) fortification and 73 infants fed a preterm formula (PF-group), from shortly before discharge to 4 months CA. Infants with serious congenital anomalies or major neonatal morbidities were excluded prior to intervention. The Wechsler Intelligence Scale for Children IV was used for cognitive testing, and the children’s parents completed the Five to Fifteen Questionnaire (FTF); (3) Results: Post-discharge fortification of MOM did not improve either full-scale intelligence quotient (FSIQ) with a median of 104 vs. 105.5 (p = 0.29), subdomain scores, or any domain score on the FTF questionnaire. Compared to the PF group, the MOM group had significantly better verbal comprehension score with a median of 110 vs. 106 (p = 0.03) and significantly better motor skills scores on the FTF questionnaire (p = 0.01); (4) Conclusions: The study supports breastfeeding without fortification as post-discharge nutrition in very preterm infants, and it seems superior to preterm formula.
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Affiliation(s)
- Anja Klamer
- Hans Christian Andersen Children’s Hospital, Odense University Hospital, 5000 Odense, Denmark; (K.G.); (S.H.); (G.Z.)
- Correspondence:
| | - Line H. Toftlund
- Department of Paediatrics, Holbaek Hospital, 4300 Holbaek, Denmark;
| | - Kristjan Grimsson
- Hans Christian Andersen Children’s Hospital, Odense University Hospital, 5000 Odense, Denmark; (K.G.); (S.H.); (G.Z.)
| | - Susanne Halken
- Hans Christian Andersen Children’s Hospital, Odense University Hospital, 5000 Odense, Denmark; (K.G.); (S.H.); (G.Z.)
- Faculty of Health Sciences, University of Southern Denmark, 5000 Odense, Denmark
| | - Gitte Zachariassen
- Hans Christian Andersen Children’s Hospital, Odense University Hospital, 5000 Odense, Denmark; (K.G.); (S.H.); (G.Z.)
- Faculty of Health Sciences, University of Southern Denmark, 5000 Odense, Denmark
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Boone KM, Klebanoff MA, Rogers LK, Rausch J, Coury DL, Keim SA. Effects of Omega-3-6-9 fatty acid supplementation on behavior and sleep in preterm toddlers with autism symptomatology: Secondary analysis of a randomized clinical trial. Early Hum Dev 2022; 169:105588. [PMID: 35644107 PMCID: PMC9516351 DOI: 10.1016/j.earlhumdev.2022.105588] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 03/01/2022] [Accepted: 05/16/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Children born extremely preterm disproportionately experience sequelae of preterm birth compared to those born at later gestational ages, including higher prevalence of autism spectrum disorder (ASD) and associated behaviors. AIM Explore effects of combined dietary docosahexaenoic acid, eicosapentaenoic acid, gamma-linolenic acid, and oleic acid (omega 3-6-9) on caregiver-reported behavior and sleep in toddlers born at ≤29 weeks' gestation who were exhibiting symptoms commonly seen with ASD. STUDY DESIGN 90-day randomized (1:1), double blinded, placebo-controlled trial. SUBJECTS Thirty-one children aged 18-38 months received omega 3-6-9 (n = 15) or canola oil placebo (n = 16). OUTCOME MEASURES Mixed effects regression analyses followed intent to treat and explored treatment effects on measures of caregiver-reported behavior (Child Behavior Checklist 1.5-5, Toddler Behavior Assessment Questionnaire - Short Form, Vineland Adaptive Behavior Scales, 2nd Edition) and sleep (Children's Sleep Habits Questionnaire, Brief Infant Sleep Questionnaire). RESULTS Twenty-nine of 31 (94%; ntx = 13, nplacebo = 16) children randomized had data available for at least one outcome measure, 27 (87%; ntx = 12, nplacebo = 15) had complete outcome data. Children randomized to omega 3-6-9 experienced a medium magnitude benefit of supplementation on anxious and depressed behaviors (ΔDifference = -1.27, d = -0.58, p = 0.049) and internalizing behaviors (ΔDifference = -3.41, d = -0.68, p = 0.05); and a large magnitude benefit on interpersonal relationship adaptive behaviors (ΔDifference = 7.50, d = 0.83, p = 0.01), compared to placebo. No effects were observed on other aspects of behavior or sleep. CONCLUSIONS Findings provide preliminary support for further exploration of omega 3-6-9 during toddlerhood to improve socioemotional outcomes among children born preterm, especially for those showing early symptoms commonly seen with ASD. Results need to be replicated in a larger sample. TRIAL REGISTRATION Registered with ClinicalTrials.gov: NCT01683565.
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Affiliation(s)
- Kelly M. Boone
- Center for Biobehavioral Health, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA,Corresponding author at: 700 Children's Drive, Columbus, OH 43205, USA. (K.M. Boone)
| | - Mark A. Klebanoff
- Center for Perinatal Research., Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA,Department of Pediatrics, College of Medicine, The Ohio State University, 370 W 9th Ave, Columbus, OH 43210, USA,Division of Epidemiology, College of Public Health, The Ohio State University, 1841 Neil Ave, Columbus, OH 43210, USA,Department of Obstetrics and Gynecology, College of Medicine, The Ohio State University, 370 W 9th Ave, Columbus, OH 43210, USA
| | - Lynette K. Rogers
- Center for Perinatal Research., Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA,Department of Pediatrics, College of Medicine, The Ohio State University, 370 W 9th Ave, Columbus, OH 43210, USA
| | - Joseph Rausch
- Center for Biobehavioral Health, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA; Department of Pediatrics, College of Medicine, The Ohio State University, 370 W 9th Ave, Columbus, OH 43210, USA.
| | - Daniel L. Coury
- Department of Pediatrics, College of Medicine, The Ohio State University, 370 W 9th Ave, Columbus, OH 43210, USA
| | - Sarah A. Keim
- Center for Biobehavioral Health, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA,Department of Pediatrics, College of Medicine, The Ohio State University, 370 W 9th Ave, Columbus, OH 43210, USA,Division of Epidemiology, College of Public Health, The Ohio State University, 1841 Neil Ave, Columbus, OH 43210, USA
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Brignoni-Pérez E, Scala M, Feldman HM, Marchman VA, Travis KE. Disparities in Kangaroo Care for Premature Infants in the Neonatal Intensive Care Unit. J Dev Behav Pediatr 2022; 43:e304-e311. [PMID: 34723932 PMCID: PMC9046459 DOI: 10.1097/dbp.0000000000001029] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 09/02/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The aim of this study was to investigate whether preterm infants whose families have lower socioeconomic status (SES) or communicate with clinical staff in a language other than English experience differences in the rate, frequency, and duration of kangaroo care (KC) in the neonatal intensive care unit (NICU) compared with preterm infants of higher SES or primarily English-speaking families. METHODS Participants were infants born <32 weeks' gestational age (GA), N = 116. We defined SES by the infants' health insurance (private/higher vs public/lower) and language by the language mothers used to communicate with clinical staff (English vs Other language). SES or language groups were compared on (1) rate of KC infants experienced during hospitalization per visitation days, (2) frequency of KC per visitation days, and (3) duration of KC events per day. RESULTS Infants in the lower SES and Other language groups experienced KC in reduced amounts, lower frequencies, and shorter durations than infants in either the higher SES or English language groups. SES and language group differences remained significant after controlling for family visitation and GA at birth. After controlling for SES, language group differences in KC duration remained significant. CONCLUSION Our findings revealed disparities in the rate, frequency, and duration of KC experienced in the NICU as a function of both SES and language. Such disparities reduced infants' access to this developmental care practice shown to stabilize clinical status and promote neurodevelopment. We recommend that hospital nurseries implement policies that minimize these disparities.
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Affiliation(s)
- Edith Brignoni-Pérez
- Department of Pediatrics, Division of Developmental-Behavioral Pediatrics, Stanford University, Stanford, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Melissa Scala
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University, Stanford, CA, USA
| | - Heidi M. Feldman
- Department of Pediatrics, Division of Developmental-Behavioral Pediatrics, Stanford University, Stanford, CA, USA
| | | | - Katherine E. Travis
- Department of Pediatrics, Division of Developmental-Behavioral Pediatrics, Stanford University, Stanford, CA, USA
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43
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Marlow N, Johnson S, Hurst JR. The extremely preterm young adult - State of the art. Semin Fetal Neonatal Med 2022; 27:101365. [PMID: 35710530 DOI: 10.1016/j.siny.2022.101365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Recently several studies have reported adult outcomes for individuals born at extremely low gestations, although they tend to be included as part of slightly more mature populations. The growth in collaborative studies allows greater confidence in the identification of persisting risk and allows us to have confidence in the likely outcomes in more contemporary cohorts. This review shows the persistence of adverse outcomes through to adult life and includes a range of outcomes including all body systems evaluated. Nonetheless adult outcomes demonstrate that most survivors appear to be free of major disabling conditions and demonstrate good participation in society. Several studies have reported outcomes in the third decade, but subsequent ageing trajectories have not yet been defined. The stability of many of the outcomes evaluated over childhood into adult life and the lack of improvement in prevalence of childhood impairments found in contemporary cohorts indicates persisting levels of risk.
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Affiliation(s)
- Neil Marlow
- Neonatal Medicine, UCL Institute for Women's Health, University College London, London, UK.
| | - Samantha Johnson
- Child Development, Department of Health Sciences, University of Leicester, Leicester, UK
| | - John R Hurst
- Respiratory Medicine, UCL Respiratory, University College London, London, UK
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Motor Performance in Association with Perceived Loneliness and Social Competence in 11-Year-Old Children Born Very Preterm. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9050660. [PMID: 35626837 PMCID: PMC9139346 DOI: 10.3390/children9050660] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 04/29/2022] [Accepted: 05/02/2022] [Indexed: 11/30/2022]
Abstract
Background: Very preterm birth may affect motor performance and social competence up to adulthood. Our objective was to describe perceived loneliness and social competence in children born very preterm in relation to motor impairment. Methods: 165 children born very preterm (birth weight ≤ 1500 g and/or gestational age < 32 weeks) were assessed at 11 years of age. Cerebral palsy (CP) was diagnosed by 2 years of age. At 11 years of age, motor outcome was assessed using the Movement Assessment Battery for Children—Second edition (Movement ABC-2). Loneliness was evaluated by using the Peer Network and Dyadic Loneliness scale and social competence by using the Multisource Assessment of Children’s Social Competence Scale. Results: In total, 6 (4%) children had CP, 18 (11%) had Developmental Coordination Disorder (DCD) (Movement ABC-2 ≤ 5th percentiles), and 141 (85%) had typical motor development. There was no correlation between percentiles for total scores of the Movement ABC-2 and perceived loneliness or social competence when the children with motor impairment (CP or DCD) were excluded. Children with DCD reported less perceived loneliness, but more problems with social competence compared to children with CP. Conclusions: It is important to recognize children born very preterm with DCD to provide interventions and support services to prevent social exclusion.
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45
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Silva W, Virtanen E, Kajantie E, Sebert S. Cognitive Function, Mental Health, and Quality of Life in Siblings of Preterm Born Children: Protocol for a Systematic Review. JMIR Res Protoc 2022; 11:e34987. [PMID: 35436229 PMCID: PMC9052026 DOI: 10.2196/34987] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/25/2022] [Accepted: 02/02/2022] [Indexed: 01/22/2023] Open
Abstract
Background Children and adults born preterm are at increased risk of cognitive impairments, mental health disorders, and poorer quality of life. Epidemiological studies have shown that the impact of preterm birth extends to the immediate family members; however, existing research have focused on parents, and little attention has been given to siblings. Objective The aim of the systematic review described in this protocol is to synthesize currently available evidence on the impact of exposure to preterm birth (ie, having a sibling born preterm) on cognition, mental health, and quality of life of term born siblings (index child) of preterm born children, and to critically appraise the evidence. Methods This protocol outlines a systematic review designed in accordance with the PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols) checklist. We will include all studies that assess outcomes in siblings of children born preterm. Quantitative and qualitative studies will be eligible for the systematic review, and only studies in English will be included. Firstly, search will be conducted electronically on PubMed, Scopus, Embase, Mednar, and opengrey.eu databases and, secondly, manually in Google Scholar and reference lists. The search strategy will include keywords and synonyms, Boolean operators, and text words (ie, within title and abstract). The team of reviewers will screen the search results, extract data from eligible studies, and critically appraise the studies. Analysis will involve both descriptive and quantitative approaches. Meta-analysis will be conducted if appropriate. Results This systematic review was registered on PROSPERO (International Prospective Register of Systematic Reviews) on December 18, 2020, and it is currently in progress. The findings will be synthesized to determine the effect of preterm birth on full-term siblings and the quality of the available evidence. Conclusions The evidence derived from this study will shed light on gaps and limitations in the field of preterm birth, more specifically, the effect of preterm birth on full-term siblings. In addition, we hope that understanding the impact of preterm birth on family members will inform targeted interventions and policies for those identified at high risk and how to mitigate health risks. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42021222887; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021222887 International Registered Report Identifier (IRRID) DERR1-10.2196/34987
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Affiliation(s)
- Wnurinham Silva
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Eeva Virtanen
- Department of Population Health, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Eero Kajantie
- Department of Population Health, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
- PEDEGO Research Unit, Medical Research Center, Oulu University Hospital, University of Oulu, Oulu, Finland
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Tehnology, Trondheim, Norway
- Pediatric Research Centre, Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Sylvain Sebert
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
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Mclean MA, Scoten OC, Yu W, Ye XY, Petrie J, Church PT, Soraisham AS, Mirea LS, Weinberg J, Synnes AR, O'Brien K, Grunau RE. Lower Maternal Chronic Physiological Stress and Better Child Behavior at 18 Months: Follow-Up of a Cluster Randomized Trial of Neonatal Intensive Care Unit Family Integrated Care. J Pediatr 2022; 243:107-115.e4. [PMID: 34971651 DOI: 10.1016/j.jpeds.2021.12.055] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 12/15/2021] [Accepted: 12/22/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess whether Family Integrated Care (FICare) in the neonatal intensive care unit improves maternal chronic physiological stress and child behavior at 18 months of corrected age for infants born preterm. STUDY DESIGN Follow-up of a multicenter, prospective cluster-randomized controlled trial comparing FICare and standard care of children born at <33 weeks of gestation and parents, stratified by tertiary neonatal intensive care units, across Canada. Primary outcomes at 18 months of corrected age were maternal stress hormones (cortisol, ie, hair cumulative cortisol [HCC], dehydroepiandrosterone [DHEA]) assayed from hair samples. Secondary outcomes included maternal reports of parenting stress, child behaviors (Internalizing, Externalizing, Dysregulation), and observer-rated caregiving behaviors. Outcomes were analyzed using multilevel modeling. RESULTS We included 126 mother-child dyads from 12 sites (6 FICare sites, n = 83; 6 standard care sites, n = 43). FICare intervention significantly lowered maternal physiological stress as indicated by HCC (B = -0.22 [-0.41, -0.04]) and cortisol/DHEA ratio (B = -0.25 [-0.48, -0.02]), but not DHEA (B = 0.01 [-0.11, 0.14]). Enrollment in FICare led to lower child Internalizing (B = -0.93 [-2.33, 0.02]) and Externalizing behavior T scores (B = -0.91 [-2.25, -0.01]) via improvements to maternal HCC (mediation). FICare buffered the negative effects of high maternal HCC on child Dysregulation T scores (B = -11.40 [-23.01, 0.21]; moderation). For mothers reporting high parenting stress at 18 months, FICare was related to lower Dysregulation T scores via maternal HCC; moderated mediation = -0.17 (-0.41, -0.01). CONCLUSIONS FICare has long-term beneficial effects for mother and child, attenuating maternal chronic physiological stress, and improving child behavior in toddlerhood. CLINICAL TRIAL REGISTRATION NCT01852695.
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Affiliation(s)
- Mia A Mclean
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Olivia C Scoten
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Wayne Yu
- Department of Cellular & Physiological Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Xiang Y Ye
- Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Julie Petrie
- BC Women's Hospital, Vancouver, British Columbia, Canada
| | - Paige T Church
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Joanne Weinberg
- Department of Cellular & Physiological Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anne R Synnes
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada; BC Women's Hospital, Vancouver, British Columbia, Canada
| | - Karel O'Brien
- Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Ruth E Grunau
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada; BC Women's Hospital, Vancouver, British Columbia, Canada.
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47
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Abstract
Individuals born extremely preterm (before 28 weeks of gestation) comprise only about 0.7% of births in the United States and an even lower proportion in other high resource countries. However, these individuals account for a disproportionate number of children with cerebral palsy, intellectual deficit, autism spectrum disorder, attention deficit hyperactivity disorder, and epilepsy. This review describes two large multiple center cohorts comprised of individuals born extremely preterm: the EPICURE cohort, recruited 1995 in the United Kingdom and the Republic of Ireland, and the Extremely Low Gestational Age Newborn (ELGAN), recruited 2002-2004 in five states in the United States. The primary focus of these studies has been neurodevelopmental disorders, but also of interest are growth, respiratory illness, and parent- and self-reported global health and well-being. Both of these studies indicate that among individuals born extremely preterm the risks of most neurodevelopmental disorders are increased. Early life factors that contribute to this risk include perinatal brain damage, some of which can be identified using neonatal head ultrasound, bronchopulmonary dysplasia, and neonatal systemic inflammation. Prenatal factors, particularly the family's socioeconomic position, also appear to contribute to risk. For most adverse outcomes, the risk is higher in males. Young adults born extremely preterm who have neurodevelopmental impairment, as compared to those without such impairment, rate their quality of life lower. However, young adults born extremely preterm who do not have neurodevelopmental impairments rate their quality of life as being similar to that of young adults born at term. Finally, we summarize the current state of interventions designed to improve the life course of extremely premature infants, with particular focus on efforts to prevent premature birth and on postnatal efforts to prevent adverse neurodevelopmental outcomes.
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Affiliation(s)
- Genevieve L Taylor
- Genevieve L Taylor MD: Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of North Carolina School of Medicine
| | - T Michael O'Shea
- T. Michael O'Shea, MD, MPH: Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of North Carolina School of Medicine.
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48
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Rodrigues C, Zeitlin J, Carvalho AR, Gonzaga D, Barros H. Behavioral and emotional outcomes at preschool age in children born very preterm: The role of breast milk feeding practices. Early Hum Dev 2022; 165:105535. [PMID: 35038626 DOI: 10.1016/j.earlhumdev.2021.105535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 11/10/2021] [Accepted: 12/22/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Breast milk feeding (BMF) improved neurodevelopment in children born very preterm (VPT, <32 weeks of gestation), but knowledge about its effect on other mental health outcomes remains limited. OBJECTIVE To estimate the association of BMF practices with behavioral and emotional problems at preschool age in children born VPT. METHODS We studied 263 children born VPT during 2011-12 and enrolled in the Portuguese EPICE cohort. At the age of 3, information on BMF initiation and duration was collected and behavioral and emotional problems were assessed using the parents' completed Child Behavior Checklist 1.5-5 years (CBCL/1½-5). Children were categorized for all CBCL/1½-5 sub-scales and for Diagnostic and Statistical Manual of Mental Disorders (DSM5)-oriented scales. Risk ratios were estimated to assess the association of BMF with subclinical/clinical problems, fitting a Poisson regression. RESULTS Behavioral or emotional subclinical/clinical problems were found in almost 20% of children (11.8% in the clinical range). BMF was consistently associated with lower adverse behavioral and emotional outcomes, particularly risks of externalizing problems, somatic complaints, aggressive behavior, as well as autism spectrum and attention deficit/hyperactivity symptoms, although the magnitude of the unadjusted risks was attenuated by adjustment for relevant confounders and wider confidence intervals included the null. CONCLUSION Lower exposure to BMF seemed to increase the risk of adverse behavioral and emotional outcomes at preschool age in children born VPT. These results raise questions about explanatory pathways and strengthen evidence underpinning BMF promotion for VPT children.
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Affiliation(s)
- Carina Rodrigues
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal.
| | - Jennifer Zeitlin
- Université de Paris, CRESS, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), INSERM, INRA, F-75004 Paris, France
| | - Ana Raquel Carvalho
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Diana Gonzaga
- Centro Materno-Infantil do Norte, Centro Hospital Universitário do Porto, Porto, Portugal
| | - Henrique Barros
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
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49
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Bailhache M, Monnier M, Moulin F, Thierry X, Vandentorren S, Côté SM, Falissard B, Simeon T, Geay B, Marchand L, Dufourg MN, Charles MA, Ancel PY, Melchior M, Rouquette A, Galera C. Emotional and attention-deficit/hyperactivity disorder symptoms of preterm vs. full-term children during COVID-19 pandemic restrictions. Pediatr Res 2022; 92:1749-1756. [PMID: 35354927 PMCID: PMC8964926 DOI: 10.1038/s41390-022-02037-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/04/2022] [Accepted: 03/13/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Preterm children are at higher risk of developing mental health problems than full-term children. Deterioration of children's mental health was observed during COVID-19 pandemic restrictive measures. Our study compared emotional and attention-deficit/hyperactivity disorder (ADHD) symptoms during school closure between preterm and full-term children. METHODS Data from two French birth cohorts-ELFE and EPIPAGE-2-were used. In 2011, infants born ≥22 weeks' gestation were recruited. Parents completed the Strengths and Difficulties Questionnaire when the children were 9 years old and experiencing school closure. Multivariate multinomial logistic regression models were used. RESULTS Subjects included 4164 full-term and 1119 preterm children. In univariate analyses, compared to full-term children: extremely and very preterm children more frequently had abnormal and borderline ADHD scores (odds ratio [OR] 1.86, 95% confidence interval [CI] 1.50-2.30, OR 1.42, 95% CI 1.08-1.85, respectively) and abnormal emotional scores (OR 1.86, 95% CI 1.43-2.40); moderate to late preterm children more often had abnormal ADHD scores (OR 1.33, 95% CI 1.01-1.78). The associations did not remain when previous symptoms at 5 years old were considered. CONCLUSIONS School closure during lockdown did not appear to increase the risk of mental health problems in preterm compared to full-term children. IMPACT STATEMENT Preterm children are at higher risk of developing mental health problems than full-term children. Deterioration in children's mental health was observed during COVID-19 pandemic restrictions. However, whether preterm children were a particularly vulnerable subgroup during school closure is unclear. In univariate analyses, extremely and very preterm children more often had abnormal and borderline ADHD symptoms and abnormal emotional symptom scores than full-term children. The associations did not remain significantly associated when previous symptoms were considered. Preterm compared to full-term children more often suffer from ADHD and emotional symptoms, but school closure during lockdown did not appear to increase this risk.
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Affiliation(s)
- Marion Bailhache
- CHU de Bordeaux, Pole de pediatrie, Place Amélie Raba Léon, F-33000, Bordeaux, France. .,Univ. Bordeaux, Bordeaux, France. .,Bordeaux Population Health Research Center, INSERM U1219, Bordeaux, France.
| | - Maeva Monnier
- grid.412041.20000 0001 2106 639XUniv. Bordeaux, Bordeaux, France ,grid.508062.90000 0004 8511 8605Bordeaux Population Health Research Center, INSERM U1219, Bordeaux, France
| | - Flore Moulin
- grid.412041.20000 0001 2106 639XUniv. Bordeaux, Bordeaux, France ,grid.508062.90000 0004 8511 8605Bordeaux Population Health Research Center, INSERM U1219, Bordeaux, France
| | - Xavier Thierry
- grid.77048.3c0000 0001 2286 7412National Institute for Demographic Studies, Paris, France
| | - Stéphanie Vandentorren
- grid.493975.50000 0004 5948 8741Santé Publique France, French National Public Health Agency, F-94415 Saint-Maurice, France
| | - Sylvana M. Côté
- grid.14848.310000 0001 2292 3357Departement of Social and Preventive Medicine, University of Montreal, Montreal, Canada
| | - Bruno Falissard
- grid.12832.3a0000 0001 2323 0229CESP, Université Paris-Saclay, UVSQ, Villejuif, France
| | - Thierry Simeon
- grid.443947.90000 0000 9751 7639Ined Inserm EFS joint unit ELFE, Paris, France
| | - Bertrand Geay
- grid.443947.90000 0000 9751 7639Ined Inserm EFS joint unit ELFE, Paris, France
| | - Laetitia Marchand
- grid.507621.7Université de Paris, INSERM, INRAE Centre for Research in Epidemiology and Statistics Paris, Paris, France
| | - Marie N. Dufourg
- grid.443947.90000 0000 9751 7639Ined Inserm EFS joint unit ELFE, Paris, France
| | - Marie A. Charles
- grid.443947.90000 0000 9751 7639Ined Inserm EFS joint unit ELFE, Paris, France ,grid.507621.7Université de Paris, INSERM, INRAE Centre for Research in Epidemiology and Statistics Paris, Paris, France
| | - Pierre Y. Ancel
- grid.507621.7Université de Paris, INSERM, INRAE Centre for Research in Epidemiology and Statistics Paris, Paris, France
| | - Maria Melchior
- grid.7429.80000000121866389Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique (IPLESP), Equipe de Recherche en Epidémiologie Sociale (ERES), Paris, France
| | - Alexandra Rouquette
- grid.12832.3a0000 0001 2323 0229CESP, Université Paris-Saclay, UVSQ, Villejuif, France ,grid.413784.d0000 0001 2181 7253Public Health and Epidemiology Department, AP-HP Paris-Saclay, Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - Cédric Galera
- grid.412041.20000 0001 2106 639XUniv. Bordeaux, Bordeaux, France ,grid.508062.90000 0004 8511 8605Bordeaux Population Health Research Center, INSERM U1219, Bordeaux, France ,Department of Child and Adolescent Psychiatry, CH Charles Perrens, Bordeaux, France
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50
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Olsen JE, Lee KJ, Spittle AJ, Anderson PJ, Doyle LW, Cheong JLY. The causal effect of being born extremely preterm or extremely low birthweight on neurodevelopment and social-emotional development at 2 years. Acta Paediatr 2022; 111:107-114. [PMID: 34494301 DOI: 10.1111/apa.16098] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 09/06/2021] [Accepted: 09/06/2021] [Indexed: 12/22/2022]
Abstract
AIM To assess the causal effect of being born extremely preterm (EP; <28 weeks' gestation) or extremely low birthweight (ELBW; <1000 g), compared with being born at term, on neurodevelopment and social-emotional development at 2 years' corrected age. METHODS Prospective geographical cohort study of children born EP/ELBW over 12 months in 2016 from Victoria, Australia, and term-born controls. Children were assessed at 2 years' corrected age with the Bayley Scales of Infant and Toddler Development-3rd edition and the Infant-Toddler Social and Emotional Assessment. Delay was defined as <-1 standard deviation relative to the mean of controls. The estimand of interest was the mean difference/odds ratio (OR) between the EP/ELBW and control groups estimated using linear/logistic regression, adjusted for multiple pregnancy and social risk. RESULTS A total of 205 EP/ELBW and 201 controls were assessed at 2 years. Delay/concerns were more common in the EP/ELBW group compared with controls, for cognitive (OR 3.7 [95% confidence interval 2.3, 6.0]), language (5.3 [3.1, 9.0]) and motor (3.9 [2.3, 6.3]) development, and social-emotional competence (4.1 [1.6, 10.2]). CONCLUSION Being born EP/ELBW has an adverse effect on cognitive, language and motor development, and social-emotional competence at 2 years' corrected age. Close developmental surveillance, including social-emotional development, is recommended.
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Affiliation(s)
- Joy E. Olsen
- Murdoch Children's Research Institute Melbourne Victoria Australia
- Neonatal Services Royal Women's Hospital Melbourne Victoria Australia
| | - Katherine J. Lee
- Murdoch Children's Research Institute Melbourne Victoria Australia
- Department of Paediatrics The University of Melbourne Melbourne Victoria Australia
| | - Alicia J. Spittle
- Murdoch Children's Research Institute Melbourne Victoria Australia
- Neonatal Services Royal Women's Hospital Melbourne Victoria Australia
- Department of Physiotherapy The University of Melbourne Melbourne Victoria Australia
| | - Peter J. Anderson
- Murdoch Children's Research Institute Melbourne Victoria Australia
- Turner Institute for Brain and Mental Health & School of Psychological Sciences Monash University Melbourne Victoria Australia
| | - Lex W. Doyle
- Murdoch Children's Research Institute Melbourne Victoria Australia
- Neonatal Services Royal Women's Hospital Melbourne Victoria Australia
- Department of Paediatrics The University of Melbourne Melbourne Victoria Australia
- Department of Obstetrics and Gynaecology The University of Melbourne Melbourne Victoria Australia
| | - Jeanie L. Y. Cheong
- Murdoch Children's Research Institute Melbourne Victoria Australia
- Neonatal Services Royal Women's Hospital Melbourne Victoria Australia
- Department of Obstetrics and Gynaecology The University of Melbourne Melbourne Victoria Australia
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