1
|
Haneda K, Hosoya M, Fujimori K, Yasumura S, Nishigori H, Kuse M, Kyozuka H, Maeda H, Sato A, Ogata Y, Hashimoto K. Gestational Age and Neurodevelopmental Delay in Term Births at 6 and 12 Months: The Japan Environment and Children's Study (JECS). Matern Child Health J 2024; 28:1031-1041. [PMID: 38466370 PMCID: PMC11058617 DOI: 10.1007/s10995-024-03908-4] [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] [Accepted: 01/09/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND In the recent years, a high risk of developmental delay not only in very low birth weight infants and late preterm infants but also in early term infants (37-38 weeks) have increasingly been reported. However, in Japan, there are virtually no studies regarding the development delays in early term infants. METHODS This study used the data from the Japan Environment and Children's Study (JECS), a birth cohort study conducted in Japan. Data were selected for analysis from the records of 104,065 fetal records. The risk of neurodevelopmental delays at 6 months and 12 months after birth was evaluated using multivariate analysis for infants of various gestational ages, using the 40th week of pregnancy as a reference value. Neurodevelopment was evaluated at 6 months and 12 months after birth using the Ages and Stages Questionnaires, Japanese translation (J-ASQ-3). RESULTS The proportion of infants born at a gestational age of 37 to 38 weeks who did not reach the J-ASQ-3 score cutoff value was significantly higher in all areas at both 6 months and 12 months after birth, when compared to that of infants born at 40 weeks. The odds ratio decreased at 12 months after birth compared to that at 6 months after birth. CONCLUSION Early term infants in Japan are at an increased risk of neurodevelopmental delay at 12 months after birth.
Collapse
Affiliation(s)
- Kentaro Haneda
- Department of Pediatrics, School of Medicine, Fukushima Medical University, 1 Hikariga-oka, Fukushima, 960-1295, Japan.
| | - Mitsuaki Hosoya
- Department of Pediatrics, School of Medicine, Fukushima Medical University, 1 Hikariga-oka, Fukushima, 960-1295, Japan
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima, Japan
| | - Keiya Fujimori
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima, Japan
- Department of Obstetrics and Gynecology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Seiji Yasumura
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima, Japan
- Department of Public Health, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Hidekazu Nishigori
- Fukushima Medical Center for Children and Women, Fukushima Medical University, Fukushima, Japan
| | - Masahito Kuse
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima, Japan
| | - Hyo Kyozuka
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima, Japan
- Department of Public Health, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Hajime Maeda
- Department of Pediatrics, School of Medicine, Fukushima Medical University, 1 Hikariga-oka, Fukushima, 960-1295, Japan
| | - Akiko Sato
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima, Japan
| | - Yuka Ogata
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima, Japan
| | - Koich Hashimoto
- Department of Pediatrics, School of Medicine, Fukushima Medical University, 1 Hikariga-oka, Fukushima, 960-1295, Japan
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima, Japan
| |
Collapse
|
2
|
Biasini A, Neri E, Stella M, Malaigia L, Mariani E, Rizzo V, Agostini F. Testing the reported long-term advantages of protein-fortified human milk in very low birth weight neonates. Front Pediatr 2024; 12:1406637. [PMID: 38853781 PMCID: PMC11157026 DOI: 10.3389/fped.2024.1406637] [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: 03/28/2024] [Accepted: 05/13/2024] [Indexed: 06/11/2024] Open
Abstract
Preterm infants are at-risk for extrauterine growth restriction and downward percentile-crossing between birth and discharge. Increased energy and protein intake through fortification of human milk during the first weeks of life has been associated with improved short-term growth and better developmental outcomes. The aim of this study was to evaluate whether these benefits persist up to children school age. The study was designed as an observational study. During hospitalization, 22 very low birth weight preterm infants were fed with increasing protein fortification of human milk (protein supplemented group, PSG). As a control group (CG), 11 preterm infants were fed with standard nutrition regimen. At children school age (9-11 years), we assessed anthropometric data (weight, height, BMI), global health (renal function), and specific psychological outcomes (Child Behavior Checklist 6-18). A global homogeneity between CG and PSG groups emerged: we found no significant differences in weight, height, and BMI, nor in internalizing symptom outcomes (all ps > 0.05). However, mothers reported significantly higher externalizing symptoms for the PSG infants compared to CG infants. Therefore, neonatal enteral protein supplementation in very low birth weight preterm infants leads to no positive nor adverse consequences in long-term assessment, suggesting that benefits are restricted to the neonatal term and first years of age.
Collapse
Affiliation(s)
- Augusto Biasini
- Donor Human Milk Bank Italian Association (AIBLUD), Milan, Italy
| | - Erica Neri
- Department of Psychology “Renzo Canestrari”, University of Bologna, Bologna, Italy
| | - Marcello Stella
- Pediatric and Neonatal Intensive Care Unit, Maurizio Bufalini Hospital, Cesena, Italy
| | - Laura Malaigia
- Pediatric and Neonatal Intensive Care Unit, Maurizio Bufalini Hospital, Cesena, Italy
| | - Elisa Mariani
- Pediatric and Neonatal Intensive Care Unit, Maurizio Bufalini Hospital, Cesena, Italy
| | - Vittoria Rizzo
- Pediatric and Neonatal Intensive Care Unit, Maurizio Bufalini Hospital, Cesena, Italy
| | - Francesca Agostini
- Department of Psychology “Renzo Canestrari”, University of Bologna, Bologna, Italy
| |
Collapse
|
3
|
Lowe J, Bann CM, Dempsey AG, Fuller J, Taylor HG, Gustafson KE, Watson VE, Vohr BR, Das A, Shankaran S, Yolton K, Ball MB, Hintz SR. Do Bayley-III Composite Scores at 18-22 Months Corrected Age Predict Full-Scale IQ at 6-7 Years in Children Born Extremely Preterm? J Pediatr 2023; 263:113700. [PMID: 37640232 PMCID: PMC10840976 DOI: 10.1016/j.jpeds.2023.113700] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/31/2023] [Accepted: 08/22/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVE To determine the ability of the Bayley-III cognitive and language composite scores at 18-22 months corrected age to predict WISC-IV Full Scale IQ (FSIQ) at 6-7 years in infants born extremely preterm. STUDY DESIGN Children in this study were part of the Neuroimaging and Neurodevelopmental Outcome cohort, a secondary study to the SUPPORT trial and born 240/7-276/7 weeks gestational age. Bayley-III cognitive and language scores and WISC-IV FSIQ were compared with pairwise Pearson correlation coefficients and adjusted for medical and socioeconomic variables using linear mixed effect regression models. RESULTS Bayley-III cognitive (r = 0.33) and language scores (r = 0.44) were mildly correlated with WISC-IV FSIQ score. Of the children with Bayley-III cognitive scores of <70, 67% also had FSIQ of <70. There was less consistency for children with Bayley-III scores in the 85-100 range; 43% had an FSIQ of <85 and 10% an FSIQ of <70. Among those with Bayley-III language scores >100, approximately 1 in 5 had an FSIQ of <85. A cut point of 92 for the cognitive composite score resulted in sensitivity (0.60), specificity (0.64). A cut point of 88 for the language composite score produced sensitivity (0.61), specificity (0.70). CONCLUSIONS Findings indicate the Bayley-III cognitive and language scores correlate with later IQ, but may fail to predict delay or misclassify children who are not delayed at school age. The Bayley-III can be a useful tool to help identify children born extremely preterm who have below average cognitive scores and may be at the greatest risk for ongoing cognitive difficulties. TRIAL REGISTRATION Extended Follow-up at School Age for the SUPPORT Neuroimaging and Neurodevelopmental Outcomes (NEURO) Cohort: NCT00233324.
Collapse
Affiliation(s)
- Jean Lowe
- Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, NM
| | - Carla M Bann
- Social, Statistical and Environmental Sciences Unit, RTI International, Research Triangle Park, NC
| | - Allison G Dempsey
- Department of Psychiatry, University of Colorado School of Medicine, University of Colorado Hospital, Denver, CO
| | - Janell Fuller
- Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, NM.
| | - H Gerry Taylor
- Department of Pediatrics, Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, OH
| | - Kathryn E Gustafson
- Department of Pediatrics, Abigail Wexner Research Institute at Nationwide Children's Hospital, The Ohio State University, Columbus, OH
| | | | - Betty R Vohr
- Department of Pediatrics, Duke University, Durham, NC
| | - Abhik Das
- Department of Pediatrics, Women & Infants Hospital, Brown University, Providence, RI
| | - Seetha Shankaran
- Social, Statistical and Environmental Sciences Unit, RTI International, Rockville, MD
| | - Kimberly Yolton
- Department of Pediatrics, Wayne State University, Detroit, MI
| | - M Bethany Ball
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH
| | - 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
| |
Collapse
|
4
|
Vanes L, Fenn-Moltu S, Hadaya L, Fitzgibbon S, Cordero-Grande L, Price A, Chew A, Falconer S, Arichi T, Counsell SJ, Hajnal JV, Batalle D, Edwards AD, Nosarti C. Longitudinal neonatal brain development and socio-demographic correlates of infant outcomes following preterm birth. Dev Cogn Neurosci 2023; 61:101250. [PMID: 37150083 PMCID: PMC10195853 DOI: 10.1016/j.dcn.2023.101250] [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: 07/06/2022] [Revised: 01/31/2023] [Accepted: 04/24/2023] [Indexed: 05/09/2023] Open
Abstract
Preterm birth results in premature exposure of the brain to the extrauterine environment during a critical period of neurodevelopment. Consequently, infants born preterm are at a heightened risk of adverse behavioural outcomes in later life. We characterise longitudinal development of neonatal regional brain volume and functional connectivity in the first weeks following preterm birth, sociodemographic factors, and their respective relationships to psychomotor outcomes and psychopathology in toddlerhood. We study 121 infants born preterm who underwent magnetic resonance imaging shortly after birth, at term-equivalent age, or both. Longitudinal regional brain volume and functional connectivity were modelled as a function of psychopathology and psychomotor outcomes at 18 months. Better psychomotor functioning in toddlerhood was associated with greater relative right cerebellar volume and a more rapid decrease over time of sensorimotor degree centrality in the neonatal period. In contrast, increased 18-month psychopathology was associated with a more rapid decrease in relative regional subcortical volume. Furthermore, while socio-economic deprivation was related to both psychopathology and psychomotor outcomes, cognitively stimulating parenting predicted psychopathology only. Our study highlights the importance of longitudinal imaging to better predict toddler outcomes following preterm birth, as well as disparate environmental influences on separable facets of behavioural development in this population.
Collapse
Affiliation(s)
- Lucy Vanes
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom; Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom.
| | - Sunniva Fenn-Moltu
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom; Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom
| | - Laila Hadaya
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom; Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Sean Fitzgibbon
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Lucilio Cordero-Grande
- Biomedical Image Technologies, TelecomunicacionETSI Telecomunicación, Universidad Politécnica de Madrid & CIBER-BBN, ISCIII, Spain
| | - Anthony Price
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom
| | - Andrew Chew
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom
| | - Shona Falconer
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom
| | - Tomoki Arichi
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom; MRC Centre for Neurodevelopmental Disorders, King's College London, United Kingdom; Paediatric Neurosciences, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Serena J Counsell
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom
| | - Joseph V Hajnal
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom
| | - Dafnis Batalle
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom; Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom
| | - A David Edwards
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom; MRC Centre for Neurodevelopmental Disorders, King's College London, United Kingdom
| | - Chiara Nosarti
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom; Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| |
Collapse
|
5
|
Keshishyan ES, Ziborova MI, Sakharova ES. Premature children and assessment of their capability for school education by 7 years of age (the role of interdisciplinary approach. ROSSIYSKIY VESTNIK PERINATOLOGII I PEDIATRII (RUSSIAN BULLETIN OF PERINATOLOGY AND PEDIATRICS) 2023. [DOI: 10.21508/1027-4065-2022-67-6-7-13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
In recent decades, there has been a distinct increase in the number of deeply and extremely preterm children without structural organic lesions of the nervous system. A comprehensive study and clinical observations of these children reveal their differences from full-term peers, becoming the most obvious by the beginning of schooling. In this article, we consider the cognitive, behavioral, and socializing features of these children, paying attention to key biosocial factors of their development, such as the long-term influence of the early neonatal period on the formation of brain structures and connections and the «resetting» of the neurohumoral system, the role of genomic polymorphism, the special importance of a favorable environment for the emotional well-being and success of these children among their peers. Knowledge and understanding of extremely preterm infants’ specific development, typical risks of behavioral disorders and social disfavor is of great practical importance for prolonged interdisciplinary follow-up — in the form of appropriate medical, educational, and psychological programs.
Collapse
Affiliation(s)
- E. S. Keshishyan
- Veltischev Research and Clinical Institute for Pediatrics of the Pirogov Russian National Research Medical University
| | - M. I. Ziborova
- Veltischev Research and Clinical Institute for Pediatrics of the Pirogov Russian National Research Medical University
| | - E. S. Sakharova
- Veltischev Research and Clinical Institute for Pediatrics of the Pirogov Russian National Research Medical University
| |
Collapse
|
6
|
Neurodevelopmental profiles of infants born <30 weeks gestation at 2 years of age. Pediatr Res 2022; 91:1579-1586. [PMID: 34880445 PMCID: PMC9177895 DOI: 10.1038/s41390-021-01871-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 11/11/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Infants born <30 weeks postmenstrual age (PMA) are at increased risk for neurodevelopmental impairment by age 2. Prior studies report rates of impairment for individual outcomes separately. Our objective was to describe neurodevelopmental profiles of children born <30 weeks PMA, using cognitive, language, motor, and behavioral characteristics. METHODS We studied 587 children from a multi-center study of infants born <30 weeks PMA. Age 2 outcomes included Bayley-III subscale scores, Child Behavior Checklist syndrome scores, diagnosis of cerebral palsy (CP), and positive screen for autism spectrum disorder (ASD) risk. We used latent profile analysis (LPA) to group children into mutually exclusive profiles. RESULTS We found four discrete neurodevelopmental profiles indicating distinct combinations of developmental and behavioral outcomes. Two of the profiles included 72.7% of the sample with most having Bayley scores within the normal range. The other two profiles included the remaining 27.3% of the sample with most having Bayley scores outside of the normal range. Only one profile (11% of sample) was comprised of children with elevated behavioral problems. CONCLUSION Child-centered analysis techniques could facilitate the development of targeted intervention strategies and provide caregivers and practitioners with an integrative understanding of child behavior. IMPACT Most studies examining neurodevelopmental outcomes in very preterm children report rates of impairment for individual outcomes separately. Comprehensive, "child-centered" approaches that integrate across multiple domains can be used to identify subgroups of children who experience different types of neurodevelopmental impairments. We identified four discrete neurodevelopmental profiles indicating distinct combinations of developmental and behavioral outcomes in very preterm children at 24 months. "Child-centered" analysis techniques may provide clinically useful information and could facilitate the development of targeted intervention strategies for high-risk children.
Collapse
|
7
|
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.
Collapse
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
| | | |
Collapse
|
8
|
Ross GS, Perlman JM. Relationship of withdrawn, anxious/depressed and attention problems to cognitive performance in preterm children at 18 months and 36 months of age. Infant Behav Dev 2021; 66:101660. [PMID: 34773854 DOI: 10.1016/j.infbeh.2021.101660] [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: 01/22/2021] [Revised: 09/17/2021] [Accepted: 10/26/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE A positive significant association has been found between behavior problems and lower cognition in very low birthweight (VLBW) preterm children at school age, but there is relatively little information about whether such an association exists in toddlers and on the continuity of this association. The aim of this study was to assess if there is a relationship between behavior problems and cognitive performance in VLBW preterm children at 18 months post conception and 3 years old, independent of socioeconomic status and sex. METHOD Parents of 124 preterm children completed a behavior rating questionnaire (Child Behavior Checklist 1.5-5) to measure behavior problems characteristic of preterm children (Withdrawn, Anxious/Depressed, and Attention Problems). Children completed the Cognitive Scale of the Bayley Scales of Infant Development-III at 18 months and the Wechsler Preschool and Primary Scale (III or IV) at 36 months old. Socioeconomic status (SES), sex, and diagnoses of autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) at 3 years were recorded for each child. RESULTS Withdrawn problems at 18 months were associated with lower cognitive scores at 18 months and both Withdrawn problems at 18 months and 36 months were associated with lower cognitive scores at 36 months. Increases in Attention Problems scores from 18 to 36 months were associated with decreases in cognitive scores over that period. Lower SES was associated with lower cognitive scores at 36 months and decreases in cognitive scores between 18 and 36 months. Sex was not related to behavior problems or cognition. Diagnoses of ASD and ADHD were significantly associated with increased Withdrawn behavior and Attention Problems, respectively. CONCLUSIONS The early association of Withdrawn behaviors with less favorable cognitive performance at 18 months and 36 months and the relationship between increases in Attention Problems with decreases in cognitive scores between the toddler and preschool period indicate the need for early assessment of and intervention for behavior problems, as well as concurrent cognitive delays, in VLBW preterm children.
Collapse
Affiliation(s)
- Gail S Ross
- Department of Pediatrics, Weill Cornell Medical College, New York, NY, USA.
| | - Jeffrey M Perlman
- Department of Pediatrics, Weill Cornell Medical College, New York, NY, USA
| |
Collapse
|
9
|
Strategies for assessing the impact of loss to follow-up on estimates of neurodevelopmental impairment in a very preterm cohort at 2 years of age. BMC Med Res Methodol 2021; 21:118. [PMID: 34092226 PMCID: PMC8182922 DOI: 10.1186/s12874-021-01264-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 03/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Loss to follow-up is a major challenge for very preterm (VPT) cohorts; attrition is associated with social disadvantage and parents with impaired children may participate less in research. We investigated the impact of loss to follow-up on the estimated prevalence of neurodevelopmental impairment in a VPT cohort using different methodological approaches. METHODS This study includes births < 32 weeks of gestational age (GA) from 4 regions in the UK and Portugal participating in a European birth cohort (N = 1737 survivors). Data on maternal characteristics, pregnancy complications, neonatal outcomes and neighborhood deprivation were collected at baseline. Neurodevelopment was assessed at 2 years of corrected age (CA) using standardized parent-report measures. We applied (1) multiple imputation (MI) and (2) inverse probability weighting (IPW) to estimate the impact of non-response on the prevalence of moderate to severe neurodevelopmental impairment and assessed violations of the missing at random (MAR) assumption using the delta method. RESULTS 54.2% of children were followed-up. Follow-up was less likely when mothers were younger, multiparous, foreign-born, did not breastfeed and came from deprived areas. The prevalence of neurodevelopmental impairment was 18.4% (95% confidence interval (CI):15.9-21.1) and increased to 20.4% (95%CI: 17.3-23.4) and 20.0% (95%CI:16.9-23.1) for MI and IPW models, respectively. Simulating strong violations of MAR (children with impairments being 50% less likely to be followed-up) raised estimates to 23.6 (95%CI:20.1-27.1) CONCLUSIONS: In a VPT cohort with high loss to follow-up, correcting for attrition yielded modest increased estimates of neurodevelopmental impairment at 2 years CA; estimates were relatively robust to violations of the MAR assumption.
Collapse
|
10
|
Gire C, Tosello B, Marret S, Cambonie G, Souksi-Medioni I, Müller JB, Garcia P, Berbis J, Auquier P, Brévaut-Malaty V, Resseguier N. Specific cognitive correlates of the quality of life of extremely preterm school-aged children without major neurodevelopmental disability. Pediatr Res 2020; 88:642-652. [PMID: 32050254 DOI: 10.1038/s41390-020-0795-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 01/09/2020] [Accepted: 01/24/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND We examined how specific cognitive behavioral impairments impacted quality of life (QoL) within a large multicenter cohort of 7-10 year olds surviving extremely preterm (EPT) without major neurodevelopmental disability. METHODS Between 7 and 10 years of age, two generic, self-proxy, and parental evaluations were obtained. QoL measurement questionnaires (Kidscreen-10/VSPA (Vécu et Santé Perçue de l'Enfant et de l'Adolescent)) were used and compared to a reference population. The general and specific cognitive functions, such as executive functions, behavior and anxiety, and clinical neurologic examination, were also assessed. RESULTS We analyzed 211 school-aged EPT children. The mean gestational age was 26.2 (±0.8) weeks, birth weight was 879 g (±181) and the mean age was 8.4 years (±0.87). Children with a Full-Scale Index Quotient ≥89, who were considered as normal, had a lower QoL. Specific cognitive impairments: comprehensive language delay, visuo-spatial integration defect, and dysexecutive disorders) were the QoL correlates in the domains of school performance and body image. CONCLUSIONS School and health care professionals need to increase their focus on EPT children's lower so as to recognize the preterm behavioral/cognitive phenotype and their potential need for supportive measures. Research on preventive interventions is warranted to investigate if these long-term effects of an EPT birth can be attenuated in neonatal period and after.
Collapse
Affiliation(s)
- Catherine Gire
- Department of Neonatology, North Hospital, APHM University Hospital, Chemin des Bourrely, 13015, Marseille, France. .,EA3279, Self-Perceived Health Assessment Research Unit, Faculty of Medicine, Marseille, 13385, France.
| | - Barthélémy Tosello
- Department of Neonatology, North Hospital, APHM University Hospital, Chemin des Bourrely, 13015, Marseille, France.,Aix-Marseille Univ, CNRS, EFS, ADES, Marseille, France
| | - Stéphane Marret
- Department of Neonatal Medicine, Rouen University Hospital and INSERM U1245, Neovasc team, Perinatal neurological handicap and Neuroprotection IRIB, Faculty of Medicine, Rouen, France
| | - Gilles Cambonie
- Department of Neonatal Medicine, Montpellier University Hospital, Montpellier, France
| | | | | | - Patricia Garcia
- Department of Neonatology, Conception Hospital, APHM University Hospital, Marseille, France
| | - Julie Berbis
- EA3279, Self-Perceived Health Assessment Research Unit, Faculty of Medicine, Marseille, 13385, France
| | - Pascal Auquier
- EA3279, Self-Perceived Health Assessment Research Unit, Faculty of Medicine, Marseille, 13385, France
| | - Véronique Brévaut-Malaty
- Department of Neonatology, North Hospital, APHM University Hospital, Chemin des Bourrely, 13015, Marseille, France
| | - Noémie Resseguier
- EA3279, Self-Perceived Health Assessment Research Unit, Faculty of Medicine, Marseille, 13385, France
| | | |
Collapse
|
11
|
Vassar R, Schadl K, Cahill-Rowley K, Yeom K, Stevenson D, Rose J. Neonatal Brain Microstructure and Machine-Learning-Based Prediction of Early Language Development in Children Born Very Preterm. Pediatr Neurol 2020; 108:86-92. [PMID: 32279900 DOI: 10.1016/j.pediatrneurol.2020.02.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 02/21/2020] [Accepted: 02/21/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Very-low-birth-weight preterm infants have a higher rate of language impairments compared with children born full term. Early identification of preterm infants at risk for language delay is essential to guide early intervention at the time of optimal neuroplasticity. This study examined near-term structural brain magnetic resonance imaging (MRI) and white matter microstructure assessed on diffusion tensor imaging (DTI) in relation to early language development in children born very preterm. METHODS A total of 102 very-low-birth-weight neonates (birthweight≤1500g, gestational age ≤32-weeks) were recruited to participate from 2010 to 2011. Near-term structural MRI was evaluated for white matter and cerebellar abnormalities. DTI fractional anisotropy, mean diffusivity, axial diffusivity, and radial diffusivity were assessed. Language development was assessed with Bayley Scales of Infant-Toddler Development-III at 18 to 22 months adjusted age. Multivariate models with leave-one-out cross-validation and exhaustive feature selection identified three brain regions most predictive of language function. Distinct logistic regression models predicted high-risk infants, defined by language scores >1 S.D. below average. RESULTS Of 102 children, 92 returned for neurodevelopmental testing. Composite language score mean ± S.D. was 89.0 ± 16.0; 31 of 92 children scored <85, including 15 of 92 scoring <70, suggesting moderate-to-severe delay. Children with cerebellar asymmetry had lower receptive language subscores (P = 0.016). Infants at high risk for language impairments were predicted based on regional white matter microstructure on DTI with high accuracy (sensitivity, specificity) for composite (89%, 86%), expressive (100%, 90%), and receptive language (100%, 90%). CONCLUSIONS Multivariate models of near-term structural MRI and white matter microstructure on DTI may assist in identification of preterm infants at risk for language impairment, guiding early intervention.
Collapse
Affiliation(s)
- Rachel Vassar
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California; Neonatal Neuroimaging Research Laboratory, Stanford University School of Medicine, Stanford, California; Division of Pediatric Neurology, Department of Neurology, University of California San Francisco, San Francisco, California.
| | - Kornél Schadl
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California; Neonatal Neuroimaging Research Laboratory, Stanford University School of Medicine, Stanford, California; Semmelweis University School of Medicine, Budapest, Hungary
| | - Katelyn Cahill-Rowley
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California; Neonatal Neuroimaging Research Laboratory, Stanford University School of Medicine, Stanford, California; Motion Analysis Laboratory, Lucile Packard Children's Hospital, Stanford, California; Department of Bioengineering, Stanford University, Stanford, California
| | - Kristen Yeom
- Division of Pediatric Neuroradiology, Department of Radiology, Stanford University, Stanford, California
| | - David Stevenson
- Neonatal Neuroimaging Research Laboratory, Stanford University School of Medicine, Stanford, California; Division of Pediatric Neonatology, Department of Pediatrics, Stanford University, Stanford, California
| | - Jessica Rose
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California; Neonatal Neuroimaging Research Laboratory, Stanford University School of Medicine, Stanford, California; Motion Analysis Laboratory, Lucile Packard Children's Hospital, Stanford, California
| |
Collapse
|
12
|
Brumbaugh JE, Bell EF, Grey SF, DeMauro SB, Vohr BR, Harmon HM, Bann CM, Rysavy MA, Logan JW, Colaizy TT, Peralta-Carcelen MA, McGowan EC, Duncan AF, Stoll BJ, Das A, Hintz SR. Behavior Profiles at 2 Years for Children Born Extremely Preterm with Bronchopulmonary Dysplasia. J Pediatr 2020; 219:152-159.e5. [PMID: 32008764 PMCID: PMC7096270 DOI: 10.1016/j.jpeds.2019.12.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 11/15/2019] [Accepted: 12/12/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To characterize behavior of 2-year-old children based on the severity of bronchopulmonary dysplasia (BPD). STUDY DESIGN We studied children born at 22-26 weeks of gestation and assessed at 22-26 months of corrected age with the Child Behavior Checklist (CBCL). BPD was classified by the level of respiratory support at 36 weeks of postmenstrual age. CBCL syndrome scales were the primary outcomes. The relationship between BPD grade and behavior was evaluated, adjusting for perinatal confounders. Mediation analysis was performed to evaluate whether cognitive, language, or motor skills mediated the effect of BPD grade on behavior. RESULTS Of 2310 children, 1208 (52%) had no BPD, 806 (35%) had grade 1 BPD, 177 (8%) had grade 2 BPD, and 119 (5%) had grade 3 BPD. Withdrawn behavior (P < .001) and pervasive developmental problems (P < .001) increased with worsening BPD grade. Sleep problems (P = .008) and aggressive behavior (P = .023) decreased with worsening BPD grade. Children with grade 3 BPD scored 2 points worse for withdrawn behavior and pervasive developmental problems and 2 points better for externalizing problems, sleep problems, and aggressive behavior than children without BPD. Cognitive, language, and motor skills mediated the effect of BPD grade on the attention problems, emotionally reactive, somatic complaints, and withdrawn CBCL syndrome scales (P values < .05). CONCLUSIONS BPD grade was associated with increased risk of withdrawn behavior and pervasive developmental problems but with decreased risk of sleep problems and aggressive behavior. The relationship between BPD and behavior is complex. Cognitive, language, and motor skills mediate the effects of BPD grade on some problem behaviors.
Collapse
Affiliation(s)
- Jane E. Brumbaugh
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
| | - Edward F. Bell
- Department of Pediatrics, University of Iowa, Iowa City, IA
| | - Scott F. Grey
- Social, Statistical and Environmental Sciences Unit, RTI International, Rockville, MD
| | - Sara B. DeMauro
- Department of Pediatrics, University of Pennsylvania, Philadelphia, PA
| | - Betty R. Vohr
- Department of Pediatrics, Brown University, Providence, RI
| | | | - Carla M. Bann
- Social, Statistical and Environmental Sciences Unit, RTI International, Research Triangle Park, NC
| | | | - J. Wells Logan
- Department of Pediatrics, Ohio State University, Columbus, OH
| | | | | | | | - Andrea F. Duncan
- Department of Pediatrics, University of Texas Health Science Center at Houston, Houston, TX
| | - Barbara J. Stoll
- Department of Pediatrics, University of Texas Health Science Center at Houston, Houston, TX
| | - Abhik Das
- Social, Statistical and Environmental Sciences Unit, RTI International, Rockville, MD
| | - Susan R. Hintz
- Department of Pediatrics, Stanford University, Palo Alto, CA
| | | |
Collapse
|
13
|
Vandewouw MM, Young JM, Mossad SI, Sato J, Whyte HAE, Shroff MM, Taylor MJ. Mapping the neuroanatomical impact of very preterm birth across childhood. Hum Brain Mapp 2019; 41:892-905. [PMID: 31692204 PMCID: PMC7267987 DOI: 10.1002/hbm.24847] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 09/16/2019] [Accepted: 10/17/2019] [Indexed: 11/10/2022] Open
Abstract
Those born very preterm (VPT; <32 weeks gestational age) have an increased risk in developing a wide range of cognitive deficits. In early-to-late childhood, brain structure has been shown to be altered in VPT compared to full-term (FT) children; however, the results are inconsistent. The current study examined subcortical volumes, cortical thickness, and surface area in a large cohort of VPT and FT children aged 4-12 years. Structural magnetic resonance imaging (MRI) was obtained on 120 VPT and 146 FT children who returned up to three times, resulting in 176 VPT and 173 FT unique data points. For each participant, Corticometric Iterative Vertex-based Estimation of Thickness was used to obtain global measurements of total brain, cortical grey and cortical white matter volumes, along with surface-based measurements of cortical thickness and surface area, and Multiple Automatically Generated Templates (MAGeT) brain segmentation tool was used to segment the subcortical structures. To examine group differences and group-age interactions, mixed-effects models were used (controlling for whole-brain volume). We found few differences between the two groups in subcortical volumes. The VPT children showed increased cortical thickness in frontal, occipital and fusiform gyri and inferior pre-post-central areas, while thinning occurred in the midcingulate. Cortical thickness in occipital regions showed more rapid decreases with age in the VPT compared to the FT children. VPT children also showed both regional increases, particularly in the temporal lobe, and decreases in surface area. Our results indicate a delayed maturational trajectory in those born VPT.
Collapse
Affiliation(s)
- Marlee M Vandewouw
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada.,Program in Neurosciences & Mental Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Julia M Young
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada.,Program in Neurosciences & Mental Health, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Psychology, University of Toronto, Toronto, Ontario, Canada
| | - Sarah I Mossad
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada.,Program in Neurosciences & Mental Health, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Psychology, University of Toronto, Toronto, Ontario, Canada
| | - Julie Sato
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada.,Program in Neurosciences & Mental Health, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Psychology, University of Toronto, Toronto, Ontario, Canada
| | - Hilary A E Whyte
- Division of Neonatology, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Manohar M Shroff
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada.,Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Margot J Taylor
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada.,Program in Neurosciences & Mental Health, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Psychology, University of Toronto, Toronto, Ontario, Canada.,Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada.,Department of Medical Imaging, University of Toronto, Toronto, Canada
| |
Collapse
|
14
|
Promoting Parenting Supports and Engagement for Infants Born Preterm. J Pediatr 2019; 210:10-12. [PMID: 31056201 DOI: 10.1016/j.jpeds.2019.03.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 03/21/2019] [Indexed: 02/07/2023]
|
15
|
McGowan EC, Vohr BR. Impact of Nonmedical Factors on Neurobehavior and Language Outcomes of Preterm Infants. Neoreviews 2019; 20:e372-e384. [PMID: 31261104 DOI: 10.1542/neo.20-7-e372] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Preterm infants are at increased risk for adverse neurodevelopmental outcomes. The impact of maternal, NICU, and social environmental factors on early neurobehavior and language outcomes of preterm infants is recognized. There is a need for health care professionals to have a clear understanding of the importance of facilitating positive mother-infant relationships, and to address not only the infant's sensory and language environment, but also focus on adverse maternal mental health and social adversities to optimize infant outcomes.
Collapse
Affiliation(s)
- Elisabeth C McGowan
- Warren Alpert Medical School of Brown University, and Department of Pediatrics, Women & Infants Hospital of Rhode Island, Providence, RI
| | - Betty R Vohr
- Warren Alpert Medical School of Brown University, and Department of Pediatrics, Women & Infants Hospital of Rhode Island, Providence, RI
| |
Collapse
|