Cognitive abilities and school performance of extremely low birth weight children and matched term control children at age 8 years: a regional study

Brain structure and function in the fourth decade of life after extremely low birth weight: An MRI and EEG study

OBJECTIVE

To examine potential long-term effects of extremely low birth weight (ELBW; ≤ 1000 g) on adult brain structure, brain function, and cognitive-behavioral performance.

METHODS

A subset of survivors from the prospectively-followed McMaster ELBW Cohort (n = 23, MBW = 816 g) and their peers born at normal birth weight (NBW; ≥ 2500 g; n = 14, MBW = 3361 g) provided T1-weighted magnetic resonance imaging (MRI) brain scans, resting electroencephalographic (EEG) recordings, and behavioral responses to a face-processing task in their early thirties.

RESULTS

Visual discrimination accuracy for human faces, resting EEG alpha power, and long-distance alpha coherence were lower in ELBW survivors than NBW adults, and volumes of white matter hypointensities (WMH) were higher. Across groups, face-processing performance was correlated positively with posterior EEG spectral power and long-distance alpha and theta coherence, and negatively with WMH. The associations between face-processing scores and parietal alpha power and theta coherence were reduced after adjustment for WMH.

CONCLUSIONS

Electrocortical activity, brain functional connectivity, and higher-order processing ability may be negatively affected by WMH burden, which is greater in adults born extremely preterm.

SIGNIFICANCE

Decrements in electrocortical activity and behavioral performance in adult ELBW survivors may be partly explained by increased WMH volumes in this vulnerable population.

Intellectual functioning in survivors of extremely low birthweight: Cognitive outcomes in childhood and adolescence

BACKGROUND

Infants born at extremely low birthweight (ELBW: ≤1000 g) are vulnerable to intellectual disabilities, but the factors that may distinguish between ELBW survivors with and without these impairments are not well understood. In this study, prospective associations between neonatal factors and functional outcomes in childhood and adolescence were compared in ELBW survivors with and without borderline intellectual functioning (BIF).

METHODS

Borderline intellectual functioning was defined by IQ < 85, assessed at 8 years. Among 146 ELBW survivors, 48 (33%) had IQ scores under 85, and 98 (67%) had scores equal to or over 85. Group differences in demographic and risk factors were assessed via t-test, chi-squared analysis or non-parametric tests. Neonatal factors that differed between ELBW groups were tested for association with adaptive behaviour assessed at age 5 years, and reading and arithmetic skills assessed at ages 8 and 15 years, using hierarchical regression models.

RESULTS

Extremely low birthweight survivors with BIF had significantly lower birthweights than ELBW survivors without BIF (790 vs. 855 g, P < 0.01) and were more likely to be born to mothers with lower socioeconomic status (SES) (78% vs. 48%, P < 0.01). These ELBW survivors also were more likely to be diagnosed with significant neurosensory impairment (NSI; 35% vs. 19%, P < 0.04), experienced more bronchopulmonary dysplasia (56% vs. 38%, P < 0.04), received more days of respiratory support (median 33 vs. 14 days, P < 0.01) and remained in hospital for longer periods (median 81 vs. 63 days, P < 0.03). Birthweight, familial SES, NSI and duration of respiratory support were significant predictors for one or more outcomes. Across groups, lower familial SES was associated with lower academic scores (Ps < 0.05), and NSI predicted lower adaptive functioning (Ps < 0.001). Other associations were moderated by group: among ELBW survivors with BIF, heavier birthweights predicted better arithmetic skills, the presence of NSI was associated with poorer arithmetic skills and more ventilation days predicted poorer reading skills.

CONCLUSIONS

At birth, ELBW survivors with BIF faced more physiological and social disadvantages and required more medical intervention than their ELBW peers without BIF. Smaller birth size, NSI burden and prolonged neonatal ventilatory support displayed gradients of risk for childhood and adolescent academic outcomes across groups. Whereas academic performance in ELBW survivors with BIF was sensitive to variation in birth size, NSI or ventilation days, ELBW survivors without BIF attained thresholds of intellectual ability that were sufficient to support higher levels of academic performance at both ages, regardless of their status on these factors. The findings are discussed in relation to Zigler's developmental theory of intellectual disability.

The relationship between child development and small for gestational age among preschool children

Objectives

This study aimed to assess the impact of small for gestational age (SGA) on the development of Taiwanese preschool children using the Chinese Child Developmental Inventory (CCDI).

Materials and Methods

A total of 982 children were enrolled in this study between June 2011 and December 2015. The samples were divided into two groups: SGA (n = 116, mean age = 2.98) and non-SGA (n = 866, mean age = 3.33) groups. The development scores were based on the CCDI, which consist of eight dimensions of development between the two groups. The linear regression analysis was adopted to examine the relationship of SGA with child development.

Results

On average, the children in the SGA group scored less in all eight subitems of the CCDI than those in the non-SGA group. However, regression analysis revealed that there was no significant difference in both performance and delay frequency in the CCDI between the two groups.

Conclusion

SGA children had similar developmental scores in CCDI as non-SGA children for preschool age in Taiwan.

Mathematical performance in childhood and early adult outcomes after very preterm birth: an individual participant data meta-analysis

AIM

To investigate the strength of the independent associations of mathematics performance in children born very preterm (<32wks' gestation or <1500g birthweight) with attending postsecondary education and their current employment status in young adulthood.

METHOD

We harmonized data from six very preterm birth cohorts from five different countries and carried out one-stage individual participant data meta-analyses (n=954, 52% female) using mixed effects logistic regression models. Mathematics scores at 8 to 11 years of age were z-standardized using contemporary cohort-specific controls. Outcomes included any postsecondary education, and employment/education status in young adulthood. All models were adjusted for year of birth, gestational age, sex, maternal education, and IQ in childhood.

RESULTS

Higher mathematics performance in childhood was independently associated with having attended any postsecondary education (odds ratio [OR] per SD increase in mathematics z-score: 1.36 [95% confidence interval {CI}: 1.03, 1.79]) but not with current employment/education status (OR 1.14 per SD increase [95% CI: 0.87, 1.48]).

INTERPRETATION

Among populations born very preterm, childhood mathematics performance is important for adult educational attainment, but not for employment status.

Cumulative risks predict epigenetic age in adult survivors of extremely low birth weight

Long-term sequelae of extremely low birth weight (ELBW; ≤1000 g) may contribute to accelerated biological aging. This hypothesis was examined by analyzing a range of risk factors with a molecular age marker in adults born at ELBW or normal birth weight (NBW; ≥2500 g). DNAm age-the weighted average of DNA methylation at 353 cytosine-phosphate-guanine (CpG) sites from across the genome-was derived from a sample of 45 ELBW (M_age  = 32.35 years) and 47 NBW control (M_age  = 32.44 years) adults, using the Illumina 850k BeadChip Array. At two assessments undertaken 9 years apart (at 23 and 32 years), cumulative risks were summed from six domains with potential to affect physiological and psychological health: resting respiratory sinus arrhythmia, blood pressure, basal cortisol, grip strength, body mass index, and self-esteem. At age 32 years, cumulative risks were differentially associated with epigenetic age in ELBW survivors (interaction, p < 0.01). For each additional risk factor they possessed, ELBW survivors (B = 1.43) were biologically 2.16 years older than NBW adults (B = -0.73), by the fourth decade of life. Developmental change, epigenetic maintenance, and intervention targets are discussed.

Low Birth Weight Prevalence in Children Diagnosed with Neurodevelopmental Disorders in Dubai

The aim of this study is to evaluate the prevalence of low birth weight and other perinatal risk factors in children diagnosed with neurodevelopmental disorders. This is one of the first studies in the Arabian Gulf region focused on the contribution of these factors toward the development of various disorders such as attention-deficit/hyperactivity disorder, autism spectrum disorder, and other mental disorders. This descriptive study was based on qualitative data analysis. We reviewed retrospective information from the electronic medical records of 692 patients in Dubai, United Arab Emirates. The prevalence of low birth weight in children with mental disorders was significantly higher as compared to the general population (16% vs 6% respectively). Furthermore, other risk factors, including high birth weight and preterm birth were noted to have a significant association with neurodevelopmental disorders. Future research on the impact of perinatal risk factors will contribute to advancement of early intervention guidelines.

Changes over time in quality of life of school-aged children born extremely preterm: 1991-2005

OBJECTIVE

To compare health-related quality of life (HRQOL) at 8 years in children born extremely preterm (EP) with contemporaneous term-born controls over three epochs: 1991-92, 1997 and 2005.

DESIGN

Prospective recruitment of geographic cohorts across three distinct eras. Utilities were calculated from the parent-completed Health Utilities Index (HUI), version 2 (1991-92 and 1997 cohorts) and version 3 (2005 cohort). Differences in utilities >0.05 are clinically important.

SETTING

The state of Victoria, Australia.

PATIENTS

475 EP (<28 weeks' gestation) and 570 term controls.

MAIN OUTCOME MEASURES

Utilities of children born EP compared with term controls within each era, and paired differences between an EP and matched controls compared across eras.

RESULTS

Overall, 86% of survivors had utility data at 8 years of age; 475 EP and 570 controls. In all eras, parent-reported utilities were lower for children born EP compared with controls (difference in medians (95% CIs); 1991-92, -0.053 (-0.071 to -0.035); 1997, -0.053 (-0.072 to -0.034); 2005, -0.082 (-0.097 to -0.068)). Mean differences (MD) between EP children and matched controls within each era were lower in the 2005 cohort compared with both the 1991-92 cohort (MD -0.054, 95% CI -0.097 to -0.010) and the 1997 cohort (MD -0.053, 95% CI -0.097 to -0.009).

CONCLUSION

Children born EP in the postsurfactant era have clinically important reductions in parent-reported HRQOL compared with controls, which may be worsening over time.

Reading and spelling skills of prematurely born children in light of the underlying cognitive factors

Prematurity is a serious risk factor for learning difficulties. Within the academic skills reading has the greatest impact on the prospects of the students; therefore, studying the reading skills in the risk populations is very important. The aim of our study was to investigate reading and spelling skills of prematurely born children. Our target group consisted of 8-11-year-old children (n = 23) who were born preterm with very low birthweights (VLBW). For comparison 57 full-term children (27 good readers and 30 dyslexics) were included in the study sample. To assess the reading and spelling abilities the Hungarian version of the 3DM (Dyslexia Differential Diagnosis) was used. Cognitive abilities were tested using the Hungarian adaptation of the WISC-IV and the Rey Complex Figure Test. The data were analyzed with a novel statistical approach using the R program. In the cognitive measures the mean performances of all three groups fell within the normal range. In the WISC-IV Full-scale IQ as well as in some other cognitive measures the good readers significantly outperformed both the dyslexics and the preterms. The findings of the study did not confirm our expectation that VLBW prematurity should lead to developmental disadvantages in the acquisition of reading and spelling skills since in the reading and spelling performances of the good readers and the preterms did not differ, while both the good readers and the preterms scored higher than the dyslexics. The results suggest that the cognitive assets of the preterm children contributing to their reading and spelling performances were their good spatial-visual memory, working memory, and processing speed. The identification of the cognitive mechanisms underlying reading and spelling abilities is of crucial importance for designing intervention for children with deficits in these academic skills.

[Formula: see text] Social-environmental moderators of neurodevelopmental outcomes in youth born preterm: A systematic review

Objective: Preterm birth represents a significant medical event that places infants at a markedly greater risk for neurodevelopmental problems and delays. Although the impact of medical factors on neurodevelopment for those born preterm has been thoroughly explored, less is known about how social-environmental factors (e.g., socioeconomic status, family functioning) moderate outcomes. This review explores the quantity and methodological rigor of research on social-environmental factors as moderators of the relationship between preterm birth and neurodevelopmental outcomes.Methods: Articles published between January 1980 and December 2016 were identified from a comprehensive meta-analysis and systematic review on neurodevelopmental outcomes following preterm birth. A systematic review of MEDLINE was conducted to identify articles published from January 2017 through April 2019.Results: Eighty articles met the inclusion criteria. The majority of studies matched preterm and control groups on social-environmental factors (n = 49). The remaining studies included social-environmental factors as moderators (n = 13) or correlates (n = 11) of neurodevelopmental outcomes. Only seven studies did not include reports on social-environmental factors.Conclusions: This systematic review suggests that social-environmental factors are often considered to be ancillary risk factors to the larger medical risk imparted by prematurity. Studies typically focused on socioeconomic status rather than more modifiable parent/family factors that can be targeted through intervention (e.g., parental mental health) and evidenced mixed findings regarding the significance of social-environmental factors as moderators. Further research is needed to identify the relative influence of social-environmental factors to inform future psychosocial interventions.

DNA methylation profiles in adults born at extremely low birth weight

Effects of stresses associated with extremely preterm birth may be biologically "recorded" in the genomes of individuals born preterm via changes in DNA methylation (DNAm) patterns. Genome-wide DNAm profiles were examined in buccal epithelial cells from 45 adults born at extremely low birth weight (ELBW; ≤1000 g) in the oldest known cohort of prospectively followed ELBW survivors (Mage = 32.35 years, 17 male), and 47 normal birth weight (NBW; ≥2500 g) control adults (Mage = 32.43 years, 20 male). Sex differences in DNAm profiles were found in both birth weight groups, but they were greatly enhanced in the ELBW group (77,895 loci) versus the NBW group (3,424 loci), suggesting synergistic effects of extreme prenatal adversity and sex on adult DNAm profiles. In men, DNAm profiles differed by birth weight group at 1,354 loci on 694 unique genes. Only two loci on two genes distinguished between ELBW and NBW women. Gene ontology (GO) and network analyses indicated that loci differentiating between ELBW and NBW men were abundant in genes within biological pathways related to neuronal development, synaptic transportation, metabolic regulation, and cellular regulation. Findings suggest increased sensitivity of males to long-term epigenetic effects of extremely preterm birth. Group differences are discussed in relation to particular gene functions.

The children of preterm survivors: shyness, parenting, and parental stress

Extremely low birth weight (ELBW) survivors have higher rates of shyness, a risk factor for poorer outcomes across the life span. Due to advances in fetal and neonatal medicine, the first generation of ELBW survivors have survived to adulthood and become parents. However, no studies have investigated the transmission of their stress vulnerability to their offspring. We explored this phenomenon using a population-based cohort of ELBW survivors and normal birth weight (NBW) controls. Using data from three generations, we examined whether the shyness and parenting stress of ELBW and NBW participants (Generation 2) mediated the relation between the parenting style of their parents (Generation 1) and shyness in their offspring (Generation 3), and the extent to which exposure to perinatal adversity (Generation 2) moderated this mediating effect. We found that among ELBW survivors, parenting stress (in Generation 2) mediated the relation between overprotective parenting style in Generation 1 (grandparents) and child shyness in Generation 3. These findings suggest that perinatal adversity and stress may be transmitted to the next generation in humans, as reflected in their perceptions of their children as shy and socially anxious, a personality phenotype that may subsequently place their children at risk of later mental and physical health problems.

Visual configural processing in adults born at extremely low birth weight

Being born at extremely low birth weight (ELBW; ≤1,000 g) is associated with enduring visual impairments. We tested for long-term, higher order visual processing problems in the oldest known prospectively followed cohort of ELBW survivors. Configural processing (spacing among features of an object) was examined in 62 adults born at ELBW (M_age  = 31.9 years) and 82 adults born at normal birth weight (NBW; ≥2,500 g: M_age  = 32.5 years). Pairs of human faces, monkey faces, or houses were presented in a delayed match-to-sample task, where non-matching stimuli differed only in the spacing of their features. Discrimination accuracy for each stimulus type was compared between birth weight groups, adjusting for neurosensory impairment, visual acuity, binocular fusion ability, IQ, and sex. Both groups were better able to discriminate human faces than monkey faces (p < .001). However, the ELBW group discriminated between human faces (p < .001), between monkey faces (p < .001), and to some degree, between houses (p < .06), more poorly than NBW control participants, suggesting a general deficit in perceptual processing. Human face discrimination was related to performance IQ (PIQ) across groups, but especially among ELBW survivors. Coding (a PIQ subtest) also predicted human face discrimination in ELBW survivors, consistent with previously reported links between visuo-perceptive difficulties and regional slowing of cortical activity in individuals born preterm. Correlations with Coding suggested ELBW survivors may have used a feature-matching approach to processing human faces. Future studies could examine brain-based anatomical and functional evidence for altered face processing, as well as the social and memory consequences of face-processing deficits in ELBW survivors.

Childhood Motor Coordination and Adult Affective Experience Among Extremely Low Birth Weight Survivors

Poor motor coordination in childhood has been associated in adulthood with more negative affect, less positive affect, and an increased risk of psychopathology. While survivors of extremely low birth weight (ELBW; < 1,000 grams) are more likely to manifest poor motor coordination than people born at normal birth weight (NBW; > 2,500 g), they have had better mental health outcomes than those with NBW who have motor difficulties. How emotion is experienced is an important risk factor for mental illness; yet, little is known about the affective experience of survivors of ELBW who also have poor motor coordination. In this longitudinal study, we examined interactions between birth weight status and childhood motor coordination on affective experience among 88 ELBW and 89 NBW participants. We first assessed childhood motor coordination at eight years of age, using the Bruininks-Oseretsky Test of Motor Proficiency, and we later gathered self-report data regarding affective style, using the Positive and Negative Affect Scedule and the Affective Styles Questionnaire, when these participants were 30-35 years of age. We found a statistically significant interaction between motor coordination and birth weight status. As motor coordination worsened among ELBW survivors, positive affect increased, while we observed the opposite trend in NBW participants (p < 0.05). There was no interaction for negative affect. Positive affect may contribute to previous findings of better relative adult mental health among ELBW survivors with poor childhood motor coordination. Strategies aimed at optimizing positive affect may be fruitful for optimizing mental health outcomes among preterm survivors and others with reduced motor proficiency.

Adult Mental Health Outcomes of Preterm Survivors Experiencing Suicidal Ideation in Adolescence

The aim of this study was to examine the link between suicidal ideation in adolescence (age 12-16) and symptoms of psychopathology in adulthood (age 22-26) in a birth cohort of extremely low birth weight (ELBW; <1000g) survivors and matched normal birth weight (NBW; >2500 g) control participants. This study utilized data from a longitudinally followed cohort of 129 ELBW survivors and 116 NBW individuals born in Ontario, Canada between the years 1977 and 1982. Participants self-reported suicidal ideation via questionnaire during adolescence (age 12-16). The depression, anxiety, inattention, and antisocial behavior subscales of the Young Adult Self Report (YASR) were used to assess symptoms of psychopathology during adulthood (age 22-26). Associations were examined in each birth weight group separately prior to and after adjustment for covariates. Before and after adjustment for covariates, suicidal ideation in NBW adolescents predicted symptoms of depression, anxiety, inattention, and antisociality in adulthood. Suicidal ideation among ELBW adolescents predicted inattentive and depressive symptoms, and antisocial behavior only before adjustment. Adolescents born at NBW who endorse suicidal ideation are at elevated risk for developing symptoms of anxiety, depression, inattention, and antisocial problems in adulthood even after adjustment. Among ELBW survivors, the risks were lower and appear to be due to confounding factors.

Child sleep problems and adult mental health in those born at term or extremely low birth weight

OBJECTIVES

To examine associations between parent-reported child sleep walking or talking, nightmares, and trouble sleeping at age eight and psychiatric problems in adulthood (age 30-35) in extremely low birth weight (ELBW; <1000 g) survivors and matched normal birth weight (NBW; >2500 g) control participants.

METHODS

At age eight, parents of ELBW survivors and NBW control participants completed sleep items on the Child Behavior Checklist assessing the presence of sleep walking/talking, nightmares, or trouble sleeping. At age 30-35, 98 ELBW and 94 NBW individuals completed the Mini International Neuropsychiatric Interview (MINI), Beck Anxiety Inventory (BAI), and Beck Depression Inventory (BDI). Analyses were conducted in each birth weight group independently.

RESULTS

In NBW participants, sleep walking/talking in childhood predicted higher BAI and BDI scores, as well as more than three times the odds of having a mood or anxiety disorder (OR = 3.48; 95% CI, 1.26-9.60) at age 30-35. Sex and childhood sleep problem interactions revealed that females who manifested sleep walking/talking as children had higher BAI scores than males. Nightmares in children born at NBW predicted higher BAI scores. These associations persisted despite adjustment for child mental health, sex, socioeconomic status, sexual or physical abuse, and family functioning. Trouble sleeping in childhood did not predict adult mental health problems. Childhood sleep problems did not predict psychopathology in ELBW adults.

CONCLUSIONS

Children born at NBW who manifest sleep walking or talking appear to be at increased risk for developing mood or anxiety disorders in adulthood. No associations between child sleep and adult mental illness were noted in those with ELBW surviviors. Childhood sleep walking/talking may be a unique risk factor for mental health problems later in life.

Trajectories of psychopathology in extremely low birth weight survivors from early adolescence to adulthood: a 20-year longitudinal study

BACKGROUND

Individuals born extremely preterm are exposed to significant perinatal stresses that are associated with an increased risk of psychopathology. However, a paucity of longitudinal studies has prevented the empirical examination of long-term, dynamic effects of perinatal adversity on mental health. Here, internalizing and externalizing problems from adolescence through adulthood were compared in individuals born at extremely low birth weight (ELBW; <1,000 g) and normal birth weight (NBW; >2,500 g).

METHODS

Internalizing and externalizing data were collected over 20 years in three waves, during adolescence, young adulthood, and adulthood. Growth models were used to compare longitudinal trajectories in a geographically based sample of 151 ELBW survivors and 137 NBW control participants born between 1977 and 1982 matched for age, sex, and socioeconomic status at age 8.

RESULTS

After adjusting for sex, socioeconomic and immigrant status, and family functioning, ELBW survivors failed to show the normative, age-related decline in internalizing problems over time relative to their NBW peers (β = .21; p < .01). Both groups exhibited small declines in externalizing problems over the same period. Self-esteem (but not physical health, IQ, or maternal mood) partially mediated the association between ELBW status and internalizing problems.

CONCLUSIONS

Extremely low birth weight survivors experienced a blunting of the expected improvement in depression and anxiety from adolescence to adulthood. These findings suggest that altered physiological regulatory systems supporting emotional and cognitive processing may contribute to the maintenance of internalizing problems in this population.

Shyness Trajectories across the First Four Decades Predict Mental Health Outcomes

Although childhood shyness is presumed to predict mental health problems in adulthood, no prospective studies have examined these outcomes beyond emerging adulthood. As well, existing studies have been limited by retrospective and cross-sectional designs and/or have examined shyness as a dichotomous construct. The present prospective longitudinal study (N = 160; 55 males, 105 females) examined shyness trajectories from childhood to the fourth decade of life and mental health outcomes. Shyness was assessed using parent- and self-rated measures from childhood to adulthood, once every decade at ages 8, 12-16, 22-26, and 30-35. At age 30-35, participants completed a structured psychiatric interview and an experimental task examining attentional biases to facial emotions. We found 3 trajectories of shyness, including a low-stable trajectory (59.4%), an increasing shy trajectory from adolescence to adulthood (23.1%), and a decreasing shy trajectory from childhood to adulthood (17.5%). Relative to the low-stable trajectory, the increasing, but not the decreasing, trajectory was at higher risk for clinical social anxiety, mood, and substance-use disorders and was hypervigilant to angry faces. We found that the development of emotional problems in adulthood among the increasing shy trajectory might be explained in part by adverse peer and social influences during adolescence. Our findings suggest different pathways for early and later developing shyness and that not all shy children grow up to have psychiatric and emotional problems, nor do they all continue to be shy.

The Immunoreactivity of PI3K/AKT Pathway After Prenatal Hypoxic Damage

BACKGROUND/AIM

There is no consensus on the effect of hypoxia on neurogenesis. In this study, we investigated the immunoreactivity of BDNF and PI3K/Akt signaling after uterine artery ligation in pregnant rats.

MATERIALS AND METHODS

Unilateral uterine artery ligation was performed at 16 days of gestation (dg). Fetuses from one horn with ligated artery were allocated to the hypoxic group. Immunohistochemistry was performed with primary antibodies; NeuN, BDNF, PI3K, Akt and phospho-Akt (pAkt).

RESULTS

The densities of NeuN- and BDNF-immunoreactive (IR) cells in the cerebral cortex were lower in the hypoxic fetuses than in the controls at 21 dg. The density of PI3K and pAkt-IR cells in the cortex of the hypoxic group significantly decreased. The results in dentate gyrus were similar to the results in the cerebral cortex.

CONCLUSION

Prenatal hypoxia reduced Akt phosphorylation, which affected neuronal survival in the cortex and dentate gyrus.

Impact of extremely low-birth-weight status on risk and resilience for depression and anxiety in adulthood

BACKGROUND

Preterm birth is associated with an increased risk of depression and anxiety, but it is not known if this is due to greater exposure to risk, or if perinatal adversity amplifies the impact of traditional risk factors. This study sought to determine if exposure to perinatal adversity modifies associations between traditional risk and resilience factors and depression and anxiety in adulthood.

METHODS

A sample of 142 extremely low-birth-weight (ELBW < 1,000 g) survivors and 133 sociodemographically matched normal birth weight (NBW) control participants was followed longitudinally to 22-26 years of age. Separate postnatal risk and resilience scales were created using eight risk and seven resilience factors, respectively. Depression and anxiety were assessed using the internalizing scale of the Young Adult Self-Report (YASR). This scale was also dichotomized at the 90th percentile to define clinically significant psychopathology.

RESULTS

While the average number of risk exposures did not differ between groups, ELBW survivors were more susceptible to risk than NBW control participants. For the ELBW group, each additional risk factor resulted in a 2-point increase in internalizing scores, and two and a half times the odds of clinically significant internalizing symptoms (OR = 2.47, 95% CI = 1.63, 3.76). The protective effect of resiliency factors was also blunted among ELBW survivors.

CONCLUSIONS

Extremely low-birth-weight survivors may be more sensitive to traditional risk factors for psychopathology and less protected by resiliency factors. Intervention strategies aimed at preventing or reducing exposure to traditional childhood risk factors for psychopathology may reduce the burden of mental illness in adult survivors of prematurity.

Overprotective Parenting and Peer Victimization in Extremely Low Birth Weight Survivors

Extremely low birth weight (ELBW; <1000g) survivors are at increased risk for experiencing both peer victimization and overprotective parenting. This study investigated if overprotective parenting moderated associations between peer victimization and psychopathology among ELBW adult survivors who have been followed since birth. Participants included 81 (31 male, 50 female) adults born with an extremely low birth weight from Ontario, Canada. The participants were predominately Caucasian. The experience of peer victimization and overprotective parenting prior to age 16 was self-reported at age 22-26 years. Peer victimization was reported using the Childhood Experiences of Violence Questionnaire and overprotective parenting was reported using the Parental Bonding Instrument. Current anxiety disorder and alcohol or substance use disorder was assessed using the MINI International Neuropsychiatric Interview at age 29-36 years. The experience of overprotective parenting moderated the association between peer victimization and risk for an anxiety disorder in adulthood (OR=2.35, 95%CI, 1.01-5.50). If the ELBW survivor reported having an overprotective parent, peer victimization was associated with increased risk for having an anxiety disorder in adulthood (OR=2.45, 95%CI, 1.13-5.30). In contrast, this association was not significant in the absence of an overprotective parent (OR=1.04, 95%CI, 0.73-1.49). Future research should further investigate if parental support and encouragement of children's independence may be important for reducing the negative effects of peer victimization among ELBW survivors.

Exposure to overprotective parenting and psychopathology in extremely low birth weight survivors

BACKGROUND

Extremely low birth weight (ELBW; <1,000 g) infants are the most vulnerable babies and are at higher risk for experiencing overprotective (i.e., controlling and intrusive) parenting, which is hypothesized to contribute to the risk for mental disorders. Despite the increased risk for anxiety disorders and decreased risk for alcohol or substance use disorders seen in ELBW survivors, no research has examined the impact of parenting. This study investigated if overprotective parenting mediates links between ELBW birth status and psychiatric disorders in adulthood.

STUDY DESIGN

Participants included ELBW survivors born in 1977-1982 and matched normal birth weight (≥2,500 g) control participants (ELBW n = 81; normal birth weight n = 87) prospectively followed in Ontario, Canada. These individuals retrospectively reported on whether either of their parents was overprotective using the Parental Bonding Instrument. Presence of a current anxiety disorder and of current alcohol or substance use disorders was assessed using the Mini International Neuropsychiatric Interview at age 29-36 years.

RESULTS

Path analysis showed that overprotective parenting was a significant mediator of the association between ELBW status and risk for an anxiety disorder in adulthood and the risk for an alcohol or substance use disorder in adulthood in ELBW survivors. Overprotective parenting accounted for 53% of the association between ELBW status and the risk for an anxiety disorder in adulthood and 26% of the association between ELBW status and alcohol or substance use disorders.

CONCLUSIONS

Overprotective parenting accounted for a substantial proportion of the increased risk for anxiety and alcohol or substance use disorders in adulthood in ELBW survivors. Despite their perceived vulnerabilities, it is important that the parents of ELBW survivors be supported in their attempts to facilitate their children's pursuit of independence during childhood and beyond.

Trajectories of self-esteem in extremely low birth weight survivors through adulthood

Although the developmental course of self-esteem has been examined in general population samples, there is a lack of research examining the trajectory of self-esteem in populations who experience unique developmental challenges. We compared the trajectory of self-esteem in extremely low birth weight (ELBW; <1000 grams) survivors and normal birth weight (NBW) controls from mid-adolescence through their early 30s. Self-esteem was reported during three follow-up periods (age 12-16, age 22-26, age 30-35). Adjusting for sex, chronic health problems, socioeconomic status, and social support, no difference was noted in self-esteem in the two groups in adolescence, but birth weight status predicted rate of change of self-esteem from adolescence to adulthood. The NBW controls showed the expected, normative increases in self-esteem from mid-adolescence to young adulthood, while ELBW individuals displayed stable, low levels of self-esteem into young adulthood. Our findings highlight that ELBW survivors may not experience the normative trajectory of self-esteem into young adulthood.

Effect of childhood coeliac disease on ninth grade school performance: evidence from a population-based study

BACKGROUND

Coeliac disease might affect school performance due to its effect on cognitive performance and related health consequences that might increase school absenteeism. The aim of this study was to investigate whether children with coeliac disease performed differently on completion of ninth grade in school compared with children without coeliac disease.

METHODS

Analysis was performed on a population of 445 669 children born in Sweden between 1991 and 1994 of whom 1767 were diagnosed with coeliac disease. School performance at ninth grade was the outcome and coeliac disease was the exposure. Other covariates included sex, Apgar score at 5 min, small for gestational age, year of birth, family type, parental education and income.

RESULTS

There was no association between coeliac disease and school performance at ninth grade (adjusted coefficient -2.4, 95% CI 5.1 to 0.4). A weak association was established between late coeliac diagnosis and higher grades, but this disappeared after adjusting for parent socioeconomic conditions. Being small for gestational age affected performance negatively (adjusted coefficient -6.9, 95% CI 8.0 to 5.7). Grade scores were significantly lower in children living with a single parent (adjusted coefficient -20.6, 95% CI 20.9 to 20.2), compared with those with married/cohabiting parents. A positive association was found between scores at ninth grade and parental education and income.

CONCLUSION

Coeliac disease diagnosis during childhood is not associated with poor school performance at ninth grade.

How do childhood intelligence and early psychosocial adversity influence income attainment among adult extremely low birth weight survivors? A test of the cognitive reserve hypothesis

Perinatal and later postnatal adversities have been shown to adversely affect socioeconomic trajectories, while enhanced early cognitive abilities improve them. However, little is known about the combined influence of these exposures on social mobility. In this study, we examined if childhood IQ moderated the association between four different types of postnatal adversity (childhood socioeconomic disadvantage, childhood sexual abuse, lifetime psychiatric disorder, and trait neuroticism) and annual earnings at 30-35 years of age in a sample of 88 extremely low birth weight survivors. Our results suggested that higher childhood IQ was associated with greater personal income at age 30-35. Extremely low birth weight survivors who did not face psychological adversities and who had higher childhood IQ reported higher income in adulthood. However, those who faced psychological adversity and had higher childhood IQ generally reported lower income in adulthood. Our findings suggest that cognitive reserve may not protect preterm survivors against the complex web of risk factors affecting their later socioeconomic attainment.

Sensitivity to facial expressions among extremely low birth weight survivors in their 30s

The current study investigated the impact of birth weight on the ability to recognize facial expressions in adulthood among the longest known prospectively followed cohort of extremely low birth weight survivors (ELBW; <1,000 g). We measured perceptual threshold to detect subtle facial expressions and confusion among different emotion categories in order to disentangle visual perceptual ability from emotional processing. ELBW adults (N = 64, M_age  = 31.9 years) were more likely than normal birth weight (NBW) controls (N = 82, M_age  = 32.5 years) to see fear in angry faces. This finding was not a result of increased perceptual efficiency in processing fearful expressions in the ELBW adults, since the two groups did not differ on their threshold to detect emotion in low intensity facial expressions. These findings suggest that a processing bias toward fear may reflect long-term developmental effects from being born at ELBW that may portend socioemotional problems that characterize ELBW survivors.

Very low birth weight is associated with brain structure abnormalities and cognitive function impairments: A systematic review

Very low birth weight (VLBW) children are at risk of structural brain abnormalities and neurocognitive deficits. Since survival rate of the very low birth weight infants has increased over the past decade, a better understanding of the long-term neurocognitive outcomes is needed. The present systematic review investigated the association between VLBW and cognitive function as well as brain structure. PubMed/Medline, Google Scholar, Scopus and Web of Science databases were searched up from January 2000 to January 2015. The study was restricted to the articles that were about VLBW and its association with cognitive function and brain structure. The initial search yielded 721 articles. There were 44 studies eligible for inclusion after applying the exclusion criteria: 24 follow-up, 14 cohort, and 6 longitudinal studies. Based on this systematic review, we suggest that VLBW is positively related to several cognitive problems and brain structure abnormalities. These findings provide evidence about the importance of early assessment of cognitive development and brain structure to identify at-risk children and provide their specific requirements as early as possible.

Neonatal Injury Results in Sex-Dependent Nociceptive Hypersensitivity and Social Behavioral Deficits During Adolescence, Without Altering Morphine Response

Neonatal injury is associated with persistent changes in sensory function and altered nociceptive thresholds that give rise to aberrant pain sensitivity in later life. Although these changes are well documented in adult rodents, little is known about the consequences of neonatal injury during adolescence. Because adolescence is a critical developmental period during which persistent pain conditions can arise, we examined the effect of neonatal injury on nociception, social behavior, and response to morphine in adolescent Sprague Dawley rats. Male and female rats exposed to plantar incision injury at postnatal day 3 displayed mechanical hypersensitivity that resolved by 24 hours after incision. When these animals reached adolescence (postnatal day 28-40), neonatally-injured male rats showed ipsilaterally restricted mechanical, heat, and cold hypersensitivity, as well as social behavioral deficits. In contrast, these effects were not seen in female rats. Neonatal injury did not alter acute morphine antinociception or the development of analgesic tolerance in either sex. Morphine-induced conditioned place preference, behavioral sensitization, and physical withdrawal were also not affected by neonatal incision. Thus, early-life injury results in sex-dependent pain-related hypersensitivity and social behavior deficits during adolescence, without altering the response to opioids.

PERSPECTIVE

Neonatal surgery has greater effects on adolescent male than female rats, resulting in pain-related hypersensitivity and social behavioral deficits. Neonatal surgery does not alter the antinociceptive effects of morphine or abuse liability.

Early developmental influences on self-esteem trajectories from adolescence through adulthood: Impact of birth weight and motor skills

While the trajectory of self-esteem from adolescence to adulthood varies from person to person, little research has examined how differences in early developmental processes might affect these pathways. This study examined how early motor skill development interacted with preterm birth status to predict self-esteem from adolescence through the early 30s. We addressed this using the oldest known, prospectively followed cohort of extremely low birth weight (<1000 g) survivors (N = 179) and normal birth weight controls (N = 145) in the world, born between 1977 and 1982. Motor skills were measured using a performance-based assessment at age 8 and a retrospective self-report, and self-esteem was reported during three follow-up periods (age 12-16, age 22-26, and age 29-36). We found that birth weight status moderated the association between early motor skills and self-esteem. Stable over three decades, the self-esteem of normal birth weight participants was sensitive to early motor skills such that those with poorer motor functioning manifested lower self-esteem, while those with better motor skills manifested higher self-esteem. Conversely, differences in motor skill development did not affect the self-esteem from adolescence to adulthood in individuals born at extremely low birth weight. Early motor skill development may exert differential effects on self-esteem, depending on whether one is born at term or prematurely.

Mental-health and educational achievement: the link between poor mental-health and upper secondary school completion and grades

BACKGROUND

Education profoundly affects adult socioeconomic status, so it is important to ensure that all children have the capability and opportunity to achieve educational goals.

AIMS

The study aimed to examine the relationship between mental-health during adolescence and upper secondary school completion and grades, which has received comparatively little research attention to date.

METHOD

Longitudinal administrative and registered data were used to analyse the relationship between school achievement and prescriptions of psycholeptic and psycho-analeptic drugs. The sample consisted of all children born in Sweden in 1990 (n = 109 223), who were followed from birth to age 20. Logistic and OLS regressions were performed separately for boys and girls, controlling for birth health and family characteristics.

RESULTS

A negative relationship between mental-health problems and educational outcomes was found; this result was almost independent of the controls. Only minor differences between the sexes were detected.

CONCLUSIONS

Poor mental-health during childhood correlated negatively with educational attainment. Given the strong link between educational success and adult life, more resources are needed to support children with mental-health problems.

Socioeconomic Attainment of Extremely Low Birth Weight Survivors: The Role of Early Cognition

OBJECTIVES

To determine: (1) if childhood cognitive and academic abilities mediate the association between being born at extremely low birth weight (ELBW) and socioeconomic attainment at age 29 to 36 years; (2) which cognitive abilities (IQ, verbal abilities, fluid intelligence, mathematical abilities, or academic achievement) most strongly mediate this association; and (3) if the mediating role of cognition is different in ELBW survivors with significant neurosensory impairment (NSI).

METHODS

A prospective, longitudinal cohort of 100 Canadian ELBW survivors born between 1977 and 1982 and 89 normal birth weight comparison participants were used to examine the mediating role of childhood cognition by using 5 cognitive mediators assessed at age 8 years (overall IQ, verbal IQ, performance IQ, quantitative ability, and academic achievement) on socioeconomic attainment at adulthood. Socioeconomic attainment was defined as personal annual earnings and full-time employment assessed via self-report at age 29 to 36 years.

RESULTS

Mediation models revealed that childhood cognition mediated the association between ELBW status and income attainment, with mathematical abilities and overall IQ each accounting for 26% of the direct effect. Mediated effects were not statistically significant in full-time employment models. For both outcomes, the mediating effect of cognition was stronger for ELBW survivors with NSI.

CONCLUSIONS

Childhood cognitive abilities partially mediate associations between ELBW status and adult income attainment. Early life cognition is a critical predictor of socioeconomic attainment in ELBW survivors, particularly in those born with NSI. Interventions aimed at enhancing early cognition in ELBW survivors may help optimize their later socioeconomic attainment.

The Association Between Unintended Births and Poor Child Development in India: Evidence from a Longitudinal Study

Evidence on the association between unintended births and poor child development in developing countries is limited. We used data from three waves of the Young Lives study on childhood poverty conducted in Andhra Pradesh in 2002, 2006-07, and 2009 to examine the association between unintended births and poor child development in India. Multivariable linear regression models were used to examine the association between unintended births and four indicators of child development-height-for-age Z-score (HAZ), Peabody Picture Vocabulary Test (PPVT) score, Mathematics Achievement Test (MAT) score, and Early Grade Reading Assessment (EGRA) test score. The Propensity Score Matching (PSM) technique was also used to analyze data. Children who were reported as unintended at birth had significantly lower HAZ, PPVT, and EGRA scores compared with those who were reported as intended. PSM results support the findings from the multivariable linear regressions. Our findings provide evidence on the association between unintended births and poor child development in India. There may be a need to reposition family planning within India's reproductive and child health care programs. Future studies must take into account the unobserved heterogeneity that our study could not address fully.

Long-term effects of peer victimization on social outcomes through the fourth decade of life in individuals born at normal or extremely low birthweight

Exposure to early adversity is known to have deleterious effects on brain-behaviour relations across the lifespan and across a range of domains. Here, we tested a cumulative risk hypothesis of adult social functioning and health outcomes in the fourth decade of life, using the oldest known longitudinally followed cohort of survivors of extremely low birthweight (ELBW; <1,000 g). We investigated the additional impact of peer victimization in youth on social outcomes at age 29-36 years in ELBW survivors and matched normal birthweight (NBW; >2,500 g) participants. In the combined sample, peer victimization was associated with lower likelihood of having children and household income, poorer family functioning and self-esteem, more loneliness and chronic health conditions, less social support, and increased likelihood for contact with police. Moderation analyses indicated that among ELBW survivors, compared to their NBW counterparts, victimization was more strongly associated with being convicted of a crime and with having chronic health conditions. These findings highlight the negative long-term impact of peer victimization on all children and that some outcomes may be differentially affected by prenatal and early post-natal environments. Statement of contribution What is already known on this subject Exposure to early adversity has deleterious effects on brain-behaviour relations across the lifespan. Extremely premature children have higher rates of exposure to adversities, including peer victimization. Peer victimization is associated with adverse outcomes in adulthood in those born at term. What does this study add? Victimization negatively impacts the social outcomes of those born extremely premature and at term into adulthood. Associations appear to be affected by individual differences in prenatal and early post-natal environments. Intervention is crucial when peer victimization occurs in children at risk, as well as those typically developing.

Health-Related Quality of Life Trajectories of Extremely Low Birth Weight Survivors into Adulthood

OBJECTIVES

To compare the health-related quality of life (HRQL) trajectories of a regional cohort of extremely low birth weight (ELBW, <1000 g) survivors (births from 1977 to 1982) and a group of normal birth weight (NBW) controls, at 3 ages: 12-16 years, 22-26 years, and 29-36 years, spanning over 20 years. We hypothesized that the HRQL of the ELBW cohort would be significantly compromised compared with their NBW peers, and that neurosensory impairments (NSI) would have an additional negative effect.

STUDY DESIGN

We used the Health Utilities Index Mark 3, in which health status was self-assessed and utility scores were derived from community preferences; multilevel modeling was used to delineate trajectories of HRQL among ELBW survivors with (n = 37) and without NSI (n = 116), and NBW controls (n = 137).

RESULTS

Adjusting for participant sex and socioeconomic status at age 8 years, ELBW survivors with NSI had consistently lower HRQL compared with both ELBW survivors without NSI and NBW controls, from adolescence through to adulthood (β = -0.264; P < .001). ELBW survivors without NSI also had significantly lower HRQL compared with NBW controls (β = -0.092; P < .01). At all ages, differences seen in the Health Utilities Index Mark 3 scores between ELBW participants and NBW controls were clinically important, though there was no differential rate of decline between the 2 groups.

CONCLUSIONS

ELBW survivors manifest meaningfully poorer HRQL from their early teens through their mid-30s. Individuals with NSI appear to represent a distinct group of ELBW survivors with substantially lower HRQL at all ages. Information on HRQL can be helpful in prioritizing research and intervention strategies.

Adult social outcomes of extremely low birth weight survivors of childhood sexual abuse

Preterm birth and exposure to childhood sexual abuse (CSA) are early physiological and psychological adversities that have been linked to reduced social functioning across the lifespan. However, the joint effects of being born preterm and being exposed to CSA on adult social outcomes remains unclear. We sought to determine the impact of exposure to both preterm birth and CSA on adult social functioning in a group of 179 extremely low birth weight (ELBW; 2500 g) participants in the fourth decade of life. Social outcome data from a prospective, longitudinal, population-based Canadian birth cohort initiated between the years of 1977 and 1982 were examined. At age 29-36 years, ELBW survivors who experienced CSA reported poorer relationships with their partner, worse family functioning, greater loneliness, lower self-esteem and had higher rates of avoidant personality problems than those who had not experienced CSA. Birth weight status was also found to moderate associations between CSA and self-esteem (P=0.032), loneliness (P=0.021) and family functioning (P=0.060), such that the adverse effects of CSA were amplified in ELBW survivors. Exposure to CSA appears to augment the adult social risks associated with perinatal adversity. Individuals born preterm and exposed to CSA appear to be a group at particularly high risk for adverse social outcomes in adulthood.

Adult mental health outcomes of child sexual abuse survivors born at extremely low birth weight

The high prevalence of child sexual abuse (CSA) is concerning, particularly as survivors are at increased risk for multiple adverse outcomes, including poor mental health across the lifespan. Children born at an extremely low birth weight (ELBW; <1000g) and who experience CSA may be a group that is especially vulnerable to psychopathology later in life. However, no research has considered the mental health risks associated with being born at ELBW and experiencing CSA. In this study, we investigated the mental health of 179 ELBW survivors and 145 matched normal birth weight (NBW; >2500g) participants at ages 22-26 and 29-36. At age 22-26, CSA was associated with increased odds of clinically significant internalizing (OR=7.32, 95% CI: 2.31-23.23) and externalizing (OR=4.65, 95% CI: 1.11-19.51) problems among ELBW participants exposed to CSA compared to those who did not, though confidence intervals were wide. At age 29-36, CSA was linked to increased odds of any current (OR=3.43, 95% CI: 1.08-10.87) and lifetime (OR=7.09, 95% CI: 2.00-25.03) non-substance use psychiatric disorders, however, this did not hold after adjustment for covariates. Statistically significant differences in mental health outcomes were not observed in NBW participants exposed to CSA compared to NBW participants who were not exposed. Survivors of significant perinatal adversity who are also exposed to CSA may be at higher risk for psychopathology through the fourth decade of life.

Childhood cognition and lifetime risk of major depressive disorder in extremely low birth weight and normal birth weight adults

In general population samples, better childhood cognitive functioning is associated with decreased risk of depression in adulthood. However, this link has not been examined in extremely low birth weight survivors (ELBW, <1000 g), a group known to have poorer cognition and greater depression risk. This study assessed associations between cognition at age 8 and lifetime risk of major depressive disorder in 84 ELBW survivors and 90 normal birth weight (NBW, ⩾2500 g) individuals up to 29-36 years of age. The Wechsler Intelligence Scale for Children, Revised (WISC-R), Raven's Coloured Progressive Matrices and the Token Test assessed general, fluid, and verbal intelligence, respectively, at 8 years of age. Lifetime major depressive disorder was assessed using the Mini International Neuropsychiatric Interview at age 29-36 years. Associations were examined using logistic regression adjusted for childhood socioeconomic status, educational attainment, age, sex, and marital status. Neither overall intelligence quotient (IQ) [WISC-R Full-Scale IQ, odds ratios (OR)=0.87, 95% confidence interval (CI)=0.43-1.77], fluid intelligence (WISC-R Performance IQ, OR=0.98, 95% CI=0.48-2.00), nor verbal intelligence (WISC-R Verbal IQ, OR=0.81, 95% CI=0.40-1.63) predicted lifetime major depression in ELBW survivors. However, every standard deviation increase in WISC-R Full-Scale IQ (OR=0.43, 95% CI=0.20-0.92) and Performance IQ (OR=0.46, 95% CI=0.21-0.97), and each one point increase on the Token Test (OR=0.80, 95% CI=0.67-0.94) at age 8 was associated with a reduced risk of lifetime depression in NBW participants. Higher childhood IQ, better fluid intelligence, and greater verbal comprehension in childhood predicted reduced depression risk in NBW adults. Our findings suggest that ELBW survivors may be less protected by superior cognition than NBW individuals.

Extremely low birth weight babies grown up: Gene-environment interaction predicts internalizing problems in the third and fourth decades of life

Extremely low birth weight (ELBW; <1000 g) infants have been exposed to stressful intrauterine and early postnatal environments. Even greater early adversity has been experienced by ELBW survivors who were also born small for gestational age (SGA; <10th percentile for GA) compared to those born appropriate for GA (AGA). ELBW survivors, particularly those born SGA, face increased risk for internalizing problems compared to normal BW (NBW; ≥2500 g) controls. Internalizing problems are related to allelic variations in the promoter region of the serotonin transporter linked polymorphic region gene (5-HTTLPR). We followed the oldest longitudinal cohort of ELBW survivors to adulthood. Participants provided buccal cells and reported on internalizing problems, using the Young Adult Self-Report when they were in their mid-20s (ELBW/SGA, N = 28; ELBW/AGA, N = 60; NBW, N = 81) and mid-30s (ELBW/SGA, N = 27; ELBW/AGA, N = 58; NBW, N = 76). The findings indicate that ELBW/SGAs carrying the 5-HTTLPR short allele reported increased internalizing problems, particularly depression, during the third and fourth decades of life. This is the first known report on gene-environment interactions predicting psychopathology among ELBW survivors. Our findings elucidate putative neurobiological pathways that underlie risk for psychopathology.

Long-term Psychiatric Impact of Peer Victimization in Adults Born at Extremely Low Birth Weight

BACKGROUND

While children born at extremely low birth weight (ELBW; <1000 g) are at elevated risk for peer victimization, no research has examined its effects on mental health in adulthood.

METHODS

ELBW survivors and matched normal birth weight (NBW; >2500 g) controls were part of a prospective, population-based study in Ontario, Canada. Peer victimization before age 16 was self-reported at age 22 to 26 years by using a 10-point measure. Presence of psychiatric disorders was examined at age 22 to 26 years (ELBW n = 142, NBW n = 133) and age 29 to 36 years (ELBW n = 84, NBW n = 90).

RESULTS

After adjustment for confounding variables, for each 1-point increase in the peer victimization score, ELBW survivors had increased odds of current depressive (odds ratio [OR] = 1.67, 95% confidence interval [CI], 1.23-2.28), anxiety (OR = 1.36, 95% CI, 1.05-1.76), avoidant (OR = 1.39, 95% CI, 1.08-1.79), antisocial (OR = 1.92, 95% CI, 1.06-2.87), and attention-deficit/hyperactivity (OR = 1.39, 95% CI, 1.06-1.83) problems at age 22 to 26 years. At age 29 to 36 years, peer victimization score predicted increased odds of current panic disorder (OR = 1.69, 95% CI, 1.01-2.83) and obsessive-compulsive disorder (OR = 3.56, 95% CI, 1.25-10.09). For NBW controls, peer victimization predicted increased odds of antisocial problems at age 22 to 26 years.

CONCLUSIONS

ELBW survivorsand NBW participants are vulnerable to the adverse psychiatric effects of childhood peer victimization in adulthood.

School Performance and Neurodevelopment of Very Low Birth Weight Preterm Infants: First Report From Turkey

Very low birth weight preterm infants are under significant risk of neurologic, developmental, and somatic problems. In this study, 90 infants born with a birth weight <1500 g and/or with a gestational age <32 weeks were evaluated after the first year of elementary school to assess neurodevelopment. The Wechsler Intelligence Scale for Children-Revised (WISC-R) test, Pediatric Symptom Checklist, and Parent Evaluation of Developmental Status were performed. Mental retardation, cerebral palsy, blindness, epilepsy, and posthemorrhagic hydrocephaly incidences were 14%, 7%, 2%, 5%, and 2%, respectively. The WISC-R score of 32 patients (35.5%) were below 85. Perinatal asphyxia, abnormal neurologic examination, and delayed or impaired speech correlated significantly with low WISC-R scores. Education and income of the father had positive impact on WISC-R scores (P = .042 and P = .026). Parents' concern and presence of cognitive problems were correlated (P = .026). Environmental factors, as well as the prevention of morbidity, affected school performance positively.

Childhood motor coordination and adult psychopathology in extremely low birth weight survivors

OBJECTIVE

To determine if childhood motor coordination is associated with lifetime major depressive disorder (MDD), current generalized anxiety disorder (GAD), and attention-deficit/hyperactivity disorder (ADHD) in adulthood, and to examine if extremely low birth weight (ELBW; <1000 g) status moderates the strength of these associations.

METHOD

Prospective study of a cohort of normal birth weight (NBW) controls and ELBW survivors. Participants completed the short form Bruininks-Oseretsky Test of Motor Proficiency (BOTMP-SF) at age 8. At age 29-36, participants completed the Mini International Neuropsychiatric Interview to diagnose the psychiatric disorders of interest.

RESULTS

Birth weight status significantly influenced the strength and direction of associations between childhood motor coordination and adult psychiatric outcomes such that the odds of MDD (Pinteraction=.02) and GAD (Pinteraction=.01) increased with worsening motor scores in NBW adults but not ELBW survivors. Stratified analyses indicated that in NBW adults, for each one-point decrease in BOTMP-SF score, the odds of lifetime MDD increased by 10% (OR=1.10, 95% CI: 1.01-1.20).

LIMITATIONS

Participant attrition reduced sample size and that may have limited our ability to detect statistically significant results for some of our analyses.

CONCLUSION

Poorer motor coordination in early life has a negative long-term impact on the development of MDD and GAD of individuals born at NBW. The long-term mental health risks of childhood motor coordination problems are significant and highlight the importance of recognizing motor deficits in all children, so that associated psychological difficulties can be identified and treated at an early age.

Peer Victimization in Extremely Low Birth Weight Survivors

BACKGROUND

Extremely low birth weight (ELBW; <1000 g) children may be at risk for experiencing peer victimization. We examined retrospectively reported peer victimization in ELBW and control children in the oldest known, prospectively followed, population-based birth cohort of ELBW survivors.

METHOD

We compared levels of verbal and physical peer victimization in ELBW and control children. We also predicted peer victimization in the ELBW sample from child characteristics.

RESULTS

ELBW children, especially girls, were at an increased risk for verbal, but not physical victimization. In addition, ELBW children with a higher IQ reported higher levels of verbal victimization, although ELBW females who had a lower body mass index in childhood reported higher levels of physical victimization.

CONCLUSION

Findings highlight the need for parents and clinicians to be aware that ELBW girls, especially those with a lower body mass index in childhood, may be at increased risk of peer victimization, as are ELBW children with a higher IQ.

Measurement Invariance Across Parent and Self-Ratings of Extremely Low Birth Weight Survivors and Normal Birth Weight Controls in Childhood and Adolescence on the Child Behavior Checklist and Youth Self-Report

OBJECTIVE

This study examined the measurement invariance of the Child Behavior Checklist (CBCL) and Youth Self-Report (YSR) DSM-oriented scales between extremely low birth weight (ELBW) and normal birth weight (NBW) youth.

METHODS

 The sample included 158 ELBW survivors and 145 matched, NBW controls at 8 and 12-16 years of age.

RESULTS

Strict invariance was established at 8 years for parent-reported CBCL attention-deficit hyperactivity, conduct, and oppositional defiant scales, though invariance could not be established for affective problems at 8 or 12-16 years. Strict invariance was observed between 12-16-year-old ELBW and NBW groups on attention-deficit hyperactivity, anxiety, and oppositional defiant CBCL and YSR scales. Invariance could not be established for youth-reported conduct problems.

CONCLUSIONS

While the majority of CBCL/YSR DSM-oriented subscales assess the same concepts in both ELBW and NBW children and adolescents across parent and youth reports, this may not be the case for affective and conduct problems.

Prem Baby Triple P: a randomised controlled trial of enhanced parenting capacity to improve developmental outcomes in preterm infants

BACKGROUND

Very preterm birth (<32 weeks gestation) is associated with motor, cognitive, behavioural and educational problems in children and maternal depression and withdrawal. Early interventions that target parenting have the greatest potential to create sustained effects on child development and parental psychopathology. Triple P (Positive Parenting Program) has shown positive effects on child behaviour and adjustment, parenting practices and family functioning. Baby Triple P for Preterm infants, has been developed to target parents of very preterm infants. This study tests the effectiveness of Baby Triple P for Preterm infants in improving child and parent/couple outcomes at 24 months corrected age (CA).

METHODS/DESIGN

Families will be randomised to receive either Baby Triple P for Preterm infants or Care as Usual (CAU). Baby Triple P for Preterm infants involves 4 × 2 hr group sessions at the hospital plus 4 × 30 min telephone consultations soon after transfer (42 weeks C.A.). After discharge participants will be linked to community based Triple P and intervention maintenance up to 24 months C.A. Assessments will be: baseline, post-intervention (6 weeks C.A.), at 12 and 24 months C.A. The primary outcome measure is the Infant Toddler Social & Emotional Assessment (ITSEA) at 24 months C.A. Child behavioural and emotional problems will be coded using the mother-toddler version of the Family Observation Schedule at 24 months C.A. Secondary outcome will be the Bayley Scales of Infant and Toddler Development (BSID III) cognitive development, language and motor abilities. Proximal targets of parenting style, parental self-efficacy, parental mental health, parental adjustment, parent-infant attachment, couple relationship satisfaction and couple communication will also be assessed. Our sample size based on the ITSEA, has 80% power, predicted effect size of 0.33 and an 85% retention rate, requires 165 families are required in each group (total sample of 330 families).

DISCUSSION

This protocol presents the study design, methods and intervention to be analysed in a randomised trial of Baby Triple P for Preterm infants compared to Care as Usual (CAU) for families of very preterm infants. Publications of all outcomes will be published in peer reviewed journals according to CONSORT guidelines.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry: ACTRN12612000194864.

The effect of the Infant Health and Development Program on special education use at school age

OBJECTIVES

To evaluate the effect of an intensive early intervention on special service use at school-age.

STUDY DESIGN

The Infant Health and Development Program was a randomized controlled trial of an intervention for low birth weight (<2500 g) infants ages 0-3 years. We used multivariate logistic regression to test the association between intervention and risk of special education, remedial reading and math, and speech therapy at age 8 years. We also compared rates of service use between study arms among those with learning disabilities (LDs).

RESULTS

There were 875 complete cases at 8-year follow-up. There were no statistically significant differences between groups in risk of special education (risk ratio [RR] 0.86, 95% CI 0.64-1.15), remedial reading (RR 0.88, 95% CI 0.68-1.14), remedial math (RR 0.92, 95% CI 0.63-1.34), or speech therapy (RR 0.87, 95% CI 0.62-1.23). The treatment arms did not differ in rates of LDs, and service use for those with LDs was low and unaffected by study group.

CONCLUSIONS

Early gains in IQ from infant interventions may not protect children as they face the educational demands of grade school. Only a fraction of those having a LD were receiving school-based support services, indicating a high level of unmet need among low birth weight children with disabilities.