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Maeda T, Tanahashi Y, Asada H, Kidokoro H, Takahashi Y, Sato Y. High threshold of total developmental quotient at 3 years for follow-up in extremely preterm infants. Early Hum Dev 2024; 196:106098. [PMID: 39116725 DOI: 10.1016/j.earlhumdev.2024.106098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 07/10/2024] [Accepted: 07/30/2024] [Indexed: 08/10/2024]
Abstract
AIM To investigate the relationship between the developmental quotient (DQ) at age 3 years and the need for educational support at school age in extremely preterm infants. METHODS A total of 176 infants with a gestational age of <28 weeks were analyzed. The total DQ and subscales were evaluated using the Kyoto Scale of Psychological Development (KSPD) test. Neurodevelopment at age 3 years was stratified using total DQ in a conventional (DQ < 70 as developmental delay, DQ 70- <85 as subnormal, DQ ≥85 as normal) and a modified way (subdividing normal into DQ 85- <93 as low-normal and DQ ≥93 as high-normal). The prevalence of future educational support was compared for each stratum. Additionally, subscales were compared between those with and without educational support in each total DQ stratum. RESULTS In conventional stratification, the prevalence of educational support was 32 (63 %) for developmental delay, 14 (24 %) for subnormal, and 10 (15 %) for normal. In modified stratification, the prevalence was 8 (26 %) for low-normal and 2 (5 %) for high-normal. While there was no significant difference in the odds of educational support between the normal and subnormal, the low-normal had significantly higher odds compared to the high-normal (OR 6.00; 95 % CI, 1.16-30.95, p = 0.03). Among the low-normal stratum, the language-social subscale was significantly lower in those with educational support. CONCLUSION Setting high thresholds for total DQ and evaluating detailed subscales at age 3 years may be useful for developmental follow-up in extremely preterm infants.
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Affiliation(s)
- Takashi Maeda
- Division of Neonatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan
| | | | - Hideyuki Asada
- Department of Pediatrics, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Aichi, Japan
| | - Hiroyuki Kidokoro
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Japan
| | - Yoshiyuki Takahashi
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Japan
| | - Yoshiaki Sato
- Division of Neonatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan.
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Starke V, Diderholm B, Heyman M, Blomqvist YT. Being parents of extremely preterm children, from a long-term perspective: A qualitative study of parents' experiences. Early Hum Dev 2023; 183:105819. [PMID: 37393662 DOI: 10.1016/j.earlhumdev.2023.105819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND In recent decades, modern neonatal intensive care has improved, increasing the survival of extremely preterm children. Few studies have examined the experiences of parents of extremely preterm children from a long-term perspective. AIM To describe parents' experiences of parenting extremely preterm children during their childhood and transition to adulthood. STUDY DESIGN A qualitative interview study with a descriptive design. SUBJECTS Thirteen parents of eleven children born at 24 gestational weeks in Sweden, 1990-1992, participated in individual semi-structured interviews. OUTCOME MEASURES Data were analyzed using qualitative reflexive thematic analysis. RESULT Five themes forming a timeline were created in the analytic process: parenthood, at the NICU, young childhood, adolescence, and adulthood. Various aspects affecting parenthood were described throughout the timeline, and occasionally the parents experienced difficulties dealing with their children's special physical and/or mental needs. Today, some families have established a functioning situation despite their children's physical and/or mental difficulties, while some still struggle with their children's everyday life. CONCLUSION Having an extremely preterm family member profoundly affects the whole family for various lengths of time. Parents expressed a need for support from both healthcare and school throughout their children's childhood and in their transition to adulthood, although the need varies between parent-child pairs. By studying the parents' experiences, their need for support can be further recognized and understood, and developed and improved accordingly.
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Affiliation(s)
- Veronica Starke
- Department of Women's and Children's Health, Uppsala University, Sweden.
| | - Barbro Diderholm
- Department of Women's and Children's Health, Uppsala University, Sweden
| | - Maria Heyman
- Department of Women's and Children's Health, Uppsala University, Sweden
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Mäkilä E, Ekblad MO, Rautava P, Lapinleimu H, Setänen S. Five-to-Fifteen-Parental Perception of Developmental Profile from Age 5 to 8 Years in Children Born Very Preterm. J Pers Med 2023; 13:jpm13050819. [PMID: 37240989 DOI: 10.3390/jpm13050819] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/09/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023] Open
Abstract
Children born very preterm have increased risk of developmental difficulties. We examined the parental perception of developmental profile of children born very preterm at 5 and 8 years by using the parental questionnaire Five-to-Fifteen (FTF) compared to full-term controls. We also studied the correlation between these age points. The study included 168 and 164 children born very preterm (gestational age < 32 weeks and/or birth weight ≤ 1500 g) and 151 and 131 full-term controls. The rate ratios (RR) were adjusted for sex and the father's educational level. At 5 and 8 years, children born very preterm were more likely to have higher scores (more difficulties) compared to controls in motor skills (RR = 2.3, CI 95% = 1.8-3.0 at 5 years and RR = 2.2, CI 95% = 1.7-2.9 at 8 years), executive function (1.7, 1.3-2.2 and 1.5, 1.2-2.0), perception (1.9, 1.4-2.5 and 1.9, 1.5-2.5), language (1.5, 1.1-1.9 and 2.2, 1.7-2.9), and social skills (1.4, 1.1-1.8 and 2.1, 1.6-2.7), and at 8 years in learning (1.9, 1.4-2.6) and memory (1.5, 1.2-2.0). There were moderate-to-strong correlations (r = 0.56-0.76, p < 0.001) in all domains between 5 and 8 years in children born very preterm. Our findings suggest that FTF might help to earlier identify children at the greatest risk of incurring developmental difficulties persisting to school-age.
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Affiliation(s)
- Eeva Mäkilä
- Department of Pediatric Neurology, University of Turku, 20014 Turku, Finland
- Salo Health Centre, 24240 Salo, Finland
| | - Mikael O Ekblad
- Department of General Practice, Institute of Clinical Medicine, Turku University Hospital, University of Turku, 20014 Turku, Finland
| | - Päivi Rautava
- Public Health, Turku Clinical Research Centre, Turku University Hospital, University of Turku, 20014 Turku, Finland
| | - Helena Lapinleimu
- Department of Pediatrics, Turku University Hospital, University of Turku, 20014 Turku, Finland
| | - Sirkku Setänen
- Department of Pediatric Neurology, University of Turku, 20014 Turku, Finland
- Department of Pediatrics, Turku University Hospital, University of Turku, 20014 Turku, Finland
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Klamer A, Toftlund LH, Grimsson K, Halken S, Zachariassen G. IQ Was Not Improved by Post-Discharge Fortification of Breastmilk in Very Preterm Infants. Nutrients 2022; 14:nu14132709. [PMID: 35807888 PMCID: PMC9268839 DOI: 10.3390/nu14132709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/26/2022] [Accepted: 06/28/2022] [Indexed: 02/04/2023] Open
Abstract
(1) Very preterm infants are at increased risk of cognitive deficits, motor impairments, and behavioural problems. Studies have tied insufficient nutrition and growth to an increased risk of neurodevelopmental impairment; (2) Methods: Follow-up study on cognitive and neuropsychological development at 6 years corrected age (CA) in 214 very preterm infants, including 141 breastfed infants randomised to mother’s own milk (MOM) with (F-MOM) or without (U-MOM) fortification and 73 infants fed a preterm formula (PF-group), from shortly before discharge to 4 months CA. Infants with serious congenital anomalies or major neonatal morbidities were excluded prior to intervention. The Wechsler Intelligence Scale for Children IV was used for cognitive testing, and the children’s parents completed the Five to Fifteen Questionnaire (FTF); (3) Results: Post-discharge fortification of MOM did not improve either full-scale intelligence quotient (FSIQ) with a median of 104 vs. 105.5 (p = 0.29), subdomain scores, or any domain score on the FTF questionnaire. Compared to the PF group, the MOM group had significantly better verbal comprehension score with a median of 110 vs. 106 (p = 0.03) and significantly better motor skills scores on the FTF questionnaire (p = 0.01); (4) Conclusions: The study supports breastfeeding without fortification as post-discharge nutrition in very preterm infants, and it seems superior to preterm formula.
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Affiliation(s)
- Anja Klamer
- Hans Christian Andersen Children’s Hospital, Odense University Hospital, 5000 Odense, Denmark; (K.G.); (S.H.); (G.Z.)
- Correspondence:
| | - Line H. Toftlund
- Department of Paediatrics, Holbaek Hospital, 4300 Holbaek, Denmark;
| | - Kristjan Grimsson
- Hans Christian Andersen Children’s Hospital, Odense University Hospital, 5000 Odense, Denmark; (K.G.); (S.H.); (G.Z.)
| | - Susanne Halken
- Hans Christian Andersen Children’s Hospital, Odense University Hospital, 5000 Odense, Denmark; (K.G.); (S.H.); (G.Z.)
- Faculty of Health Sciences, University of Southern Denmark, 5000 Odense, Denmark
| | - Gitte Zachariassen
- Hans Christian Andersen Children’s Hospital, Odense University Hospital, 5000 Odense, Denmark; (K.G.); (S.H.); (G.Z.)
- Faculty of Health Sciences, University of Southern Denmark, 5000 Odense, Denmark
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Gire C, Garbi A, Zahed M, Beltran Anzola A, Tosello B, Datin-Dorrière V. Neurobehavioral Phenotype and Dysexecutive Syndrome of Preterm Children: Comorbidity or Trigger? An Update. CHILDREN (BASEL, SWITZERLAND) 2022; 9:239. [PMID: 35204960 PMCID: PMC8870742 DOI: 10.3390/children9020239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 01/29/2022] [Accepted: 02/09/2022] [Indexed: 06/14/2023]
Abstract
Premature birth is a worldwide public health priority. One in ten children is born before 37 weeks of gestational age and, in developed countries, survival rates without major neonatal morbidity are increasing. Although severe sequelae associated with these births have decreased, their neurobehavioral difficulties, often associated in multiple fields, remain stable but still widespread. These neurobehavioral difficulties hamper the normal development of academic achievements and societal integration and intensify the children's needs for rehabilitation during their preschool and academic years. Severe sequelae increase when gestational age decreases. This is even truer if the socio-cultural background is impeded by low income, education and language skills as compared with defined averages. However, moderate and/or minor neurocognitive and/or behavioral difficulties are almost identical for a moderate or a late preterm birth. Obtaining a better clinical description of neurobehavioral characteristics of those pretermly born, once they reach preschool age, is essential to detect behavioral issues as well as early specific cognitive difficulties (working memory, planning, inhibition, language expression and reception, attention and fine motor skills, etc.). Such information would provide a better understanding of the executive functions' role in brain connectivity, neurodevelopment and neuroanatomical correlation with premature encephalopathy.
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Affiliation(s)
- Catherine Gire
- Department of Neonatology, North Hospital, University Hospital of Marseille, Chemin des Bourrelys, CEDEX 20, 13915 Marseille, France; (C.G.); (A.G.); (M.Z.); (A.B.A.)
- CEReSS—Health Service Research and Quality of Life Center, Faculty of Medicine, Aix-Marseille University, 27 Boulevard Jean Moulin, 13005 Marseille, France
| | - Aurélie Garbi
- Department of Neonatology, North Hospital, University Hospital of Marseille, Chemin des Bourrelys, CEDEX 20, 13915 Marseille, France; (C.G.); (A.G.); (M.Z.); (A.B.A.)
| | - Meriem Zahed
- Department of Neonatology, North Hospital, University Hospital of Marseille, Chemin des Bourrelys, CEDEX 20, 13915 Marseille, France; (C.G.); (A.G.); (M.Z.); (A.B.A.)
| | - Any Beltran Anzola
- Department of Neonatology, North Hospital, University Hospital of Marseille, Chemin des Bourrelys, CEDEX 20, 13915 Marseille, France; (C.G.); (A.G.); (M.Z.); (A.B.A.)
- CEReSS—Health Service Research and Quality of Life Center, Faculty of Medicine, Aix-Marseille University, 27 Boulevard Jean Moulin, 13005 Marseille, France
| | - Barthélémy Tosello
- Department of Neonatology, North Hospital, University Hospital of Marseille, Chemin des Bourrelys, CEDEX 20, 13915 Marseille, France; (C.G.); (A.G.); (M.Z.); (A.B.A.)
- CNRS, EFS, ADES, Aix Marseille Universite, 13915 Marseille, France
| | - Valérie Datin-Dorrière
- Department of Neonatal Medicine, Caen University Hospital, Avenue Cote De Nacre, 14000 Caen, France;
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Galán-Megías R, Lanzarote-Fernández MD, Casanovas-Lax J, Padilla-Muñoz EM. Interaction of Impulsivity, Attention, and Intelligence in Early Adolescents Born Preterm without Sequelae. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179043. [PMID: 34501631 PMCID: PMC8431711 DOI: 10.3390/ijerph18179043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 08/21/2021] [Accepted: 08/23/2021] [Indexed: 11/16/2022]
Abstract
There is insufficient evidence on the intellectual and attentional profile of adolescents born prematurely. Aim: to identify maladjustment in intellectual and attention skills at the beginning of secondary school. Method: 69 premature 12-year-old adolescents were evaluated with the WISC, d2 Test of Attention, and Test of Perception of Differences-Revised (CARAS-R). Results: adolescents present intellectual and attention abilities in the normal range. However, all premature adolescents show difficulties in impulse control and female adolescents are better in processing speed. Depending on the category of prematurity, differences in attention skills are evident. Conclusion: adolescents born prematurely without associated sequelae have significantly lower performance in the same areas than the normative group. This could affect the cognitive control of their behavior and academic performance in the medium and long term. Great prematurity could interfere with attention skills and self-control even at the age of 12, especially in males.
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Affiliation(s)
- Rocío Galán-Megías
- International Doctoral School, University of Seville, 41004 Seville, Spain;
| | - María Dolores Lanzarote-Fernández
- Department of Personality, Assessment and Psychological Treatments, University of Seville, 41018 Seville, Spain;
- Pediatrics Integral and Pediatric Psychology Research Group CTS-152, Consejería de Salud, Junta de Andalucía, 11620 Andalusia, Spain
- Correspondence:
| | - Javier Casanovas-Lax
- Paediatrics Clinical Management Unit, University Hospital of Valme, 41014 Sevilla, Spain;
| | - Eva María Padilla-Muñoz
- Department of Personality, Assessment and Psychological Treatments, University of Seville, 41018 Seville, Spain;
- Pediatrics Integral and Pediatric Psychology Research Group CTS-152, Consejería de Salud, Junta de Andalucía, 11620 Andalusia, Spain
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7
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Teixeira R, Queiroga AC, Freitas AI, Lorthe E, Santos AC, Moreira C, Barros H. Completeness of Retention Data and Determinants of Attrition in Birth Cohorts of Very Preterm Infants: A Systematic Review. Front Pediatr 2021; 9:529733. [PMID: 33681095 PMCID: PMC7925642 DOI: 10.3389/fped.2021.529733] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 01/11/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Birth cohorts provided essential knowledge for clinical and public health decision-making. However, little is known about retention and determinants of attrition in these specific longitudinal studies, although characterizing predictors of attrition sets the path to mitigate its occurrence and to promote valid inferences. We systematically reviewed retention in follow-ups of birth cohorts of very preterm or very low birth weight infants and the determinants of attrition. PROSPERO registration number: CRD42017082672. Methods: Publications were identified through PubMed®, Scopus, Web of Science, and Cochrane Library databases from inception to December 2017. Studies were included when reporting at least one of the following: retention at follow-ups, reasons for attrition, or characteristics of non-participants. Quality assessment was conducted using the completeness of the report of participation features in the articles. Non-participant's characteristics were presented using descriptive statistics. Local polynomial regression was used to describe overall retention trends over years of follow-up. Results: We identified 57 eligible publications, reporting on 39 birth cohorts and describing 83 follow-up evaluations. The overall median retention was 87% (p25-p75:75.8-93.6), ranging from 14.6 to 100%. Overall, retention showed a downward trend with increasing child age. Completeness of retention report was considered "enough" in only 36.8% of publications. Considering the 33 (57.9%) publications providing information on participants and non-participants, and although no formal meta-analysis was performed, it was evident that participants lost to follow-up were more often male, had foreign-born, multiparous, and younger mothers, and with a lower socioeconomic status. Conclusion: This systematic review evidenced a lack of detailed data on retention, which may threaten the potential use of evidence derived from cohort studies of very preterm infants for clinical and public health purpose. It supports the requirement for a standardized presentation of retention features responding to current guidelines.
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Affiliation(s)
- Raquel Teixeira
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | | | - Ana Isabel Freitas
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Elsa Lorthe
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Ana Cristina Santos
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Carla Moreira
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,CMAT - Centro de Matemática, Universidade do Minho, Braga, Portugal
| | - Henrique Barros
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
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8
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Predictive Value of the Global School Adaptation Questionnaire at 5 Years of Age and Educational Support at 7 Years of Age in Very Preterm Children. J Pediatr 2020; 226:129-134.e1. [PMID: 32615196 DOI: 10.1016/j.jpeds.2020.06.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 06/08/2020] [Accepted: 06/19/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To assess the Global School Adaptation (GSA) questionnaire of children's abilities and classroom behavior administered to teachers of very preterm children at 5 years of age as a predictor of the need for educational support (grade retention, special class, learning support) at age 7. STUDY DESIGN We assessed 858 very preterm children (<33 weeks of gestation) at 5 years of age using the GSA and again at 7 years to determine the use of educational support. We examined the association between the GSA score and educational support at 7 years and performed a receiver operating characteristic curve analysis. RESULTS At 7 years of age, 130 children had educational support (15.2%). Children with a nonoptimal GSA score (<45) at 5 years required educational support more often (57.7%) than children with a GSA score of 45 or greater (15.4%) (OR, 7.5; 95% CI, 5.02-11.21). The need for educational support was associated with male sex; a low parent socioeconomic level; lower birth weight, birth head circumference, or gestational age (28-30 weeks of gestation); severe neurologic complications; patent ductus arteriosus ligation; and the use of therapy services at 5 years of age. After adjustment, only the GSA score was associated with educational support at 7 years of age (OR, 0.86; 95% CI, 0.84-0.88). A receiver operating characteristic curve analysis of the GSA performance revealed an optimal cut-off at 48, with a sensitivity of 70.8%, a specificity of 73.5%, and an area under the curve of 0.79. CONCLUSIONS Using a cut-off score of 48, the GSA at 5 years of age may be a useful tool to identify children born preterm at risk of school-based learning difficulties.
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9
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Domellöf E, Johansson AM, Farooqi A, Domellöf M, Rönnqvist L. Risk for Behavioral Problems Independent of Cognitive Functioning in Children Born at Low Gestational Ages. Front Pediatr 2020; 8:311. [PMID: 32676487 PMCID: PMC7333186 DOI: 10.3389/fped.2020.00311] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 05/14/2020] [Indexed: 11/28/2022] Open
Abstract
This study aimed to investigate cognitive and behavioral outcomes in relation to gestational age (GA) in school-aged children born preterm (PT). Results from the Wechsler Intelligence Scale for Children, 4th edition (WISC-IV), and the Child Behavior Checklist (CBCL) were analyzed in 51 children (mean age: 7.8 years [range: 7.0-8.7]) born PT (mean GA: 31 weeks [range: 23-35]; birth weight, mean: 1,637 g [range: 404-2,962]) with the majority (96%) having no diagnosed cognitive, sensory, or motor impairments. The control group included 57 age-matched typically developing children (mean age: 7.9 years [range: 6.2-8.7]) born full-term (FT). Children born PT, extremely PT (GA < 28) in particular, showed significantly lower cognitive performance and higher behavioral problem scores compared with children born FT. GA was found to predict aspects of both cognitive functioning and behavioral problems within the PT group, with lower GA being related to both poorer cognitive outcomes and elevated affective and attention-deficit/hyperactivity problems. Global cognitive functioning did not independently predict aspects of behavioral outcomes. Findings demonstrate that, even in children born PT without severe perinatal and/or postnatal complications and receiving active perinatal care, a short gestation is an evident risk factor for long-term negative effects on mental health independent of cognitive functioning. Additional findings suggest that both reduced growth and lower parental educational level may contribute to increased risk for poorer cognitive and behavioral functioning in children born PT.
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Affiliation(s)
- Erik Domellöf
- Department of Psychology, Umeå University, Umeå, Sweden
| | | | - Aijaz Farooqi
- Division of Pediatrics, Department of Clinical Sciences, Umeå University, Umeå, Sweden
| | - Magnus Domellöf
- Division of Pediatrics, Department of Clinical Sciences, Umeå University, Umeå, Sweden
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10
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Nyman A, Korhonen T, Lehtonen L, Haataja L, Aho K, Ahtola A, Ekblad M, Ekblad S, Ekholm E, Hagelstam C, Huhtala M, Juntunen M, Kero P, Koivisto M, Korja R, Korpela S, Lahti K, Lapinleimu H, Lehtonen T, Leppänen M, Lind A, Manninen H, Matomäki J, Maunu J, Munck P, Määttänen L, Niemi P, Palo P, Parkkola R, Rautava L, Rautava P, Saarinen K, Salomäki S, Saunavaara V, Setänen S, Sillanpää M, Stolt S, Tuomikoski‐Koiranen P, Tuovinen T, Väliaho A, Ylijoki M. School performance is age appropriate with support services in very preterm children at 11 years of age. Acta Paediatr 2019; 108:1669-1676. [PMID: 30788870 PMCID: PMC6766940 DOI: 10.1111/apa.14763] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 01/22/2019] [Accepted: 02/18/2019] [Indexed: 12/01/2022]
Abstract
Aim This Finnish regional birth‐cohort study compared the school performance of very preterm and full‐term children when they reached 11 years of age. Methods Teachers rated the educational abilities of 123 preterm children and 133 full‐term controls at the age of 11 years as well as the support services they received. The children were all born in the Turku University Hospital between 2001 and 2005. In the preterm group, neurosensory impairments were confirmed at two years of corrected age, and full‐scale intelligence quotient (IQ) was assessed at 11 years of age using the Wechsler Intelligence Scale, Fourth Edition. Results Educational abilities, including academic skills and classroom functioning, did not differ between the two groups after excluding the children with a full‐scale IQ < 70. However, 40% of the preterm group and 26% of the controls had received at least one support service (p <0.02). The 13 preterm children with a full‐scale IQ <70 and the 10 with neurosensory impairment received more support services. Boys in both groups displayed more classroom‐functioning problems than girls. Conclusion A full‐scale IQ ≥ 70 and age‐appropriate educational abilities do not exclude a significant need for support services in very preterm children at the age of 11 years.
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Affiliation(s)
- Anna Nyman
- Department of Psychology University of Turku Turku Finland
- Department of Pediatrics University of Turku Turku University Hospital Turku Finland
| | - Tapio Korhonen
- Department of Psychology University of Turku Turku Finland
| | - Liisa Lehtonen
- Department of Pediatrics University of Turku Turku University Hospital Turku Finland
| | - Leena Haataja
- Pediatric Research Center Children's Hospital University of Helsinki Helsinki University Hospital Helsinki Finland
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11
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Miquel M, Nicola SM, Gil-Miravet I, Guarque-Chabrera J, Sanchez-Hernandez A. A Working Hypothesis for the Role of the Cerebellum in Impulsivity and Compulsivity. Front Behav Neurosci 2019; 13:99. [PMID: 31133834 PMCID: PMC6513968 DOI: 10.3389/fnbeh.2019.00099] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 04/23/2019] [Indexed: 12/27/2022] Open
Abstract
Growing evidence associates cerebellar abnormalities with several neuropsychiatric disorders in which compulsive symptomatology and impulsivity are part of the disease pattern. Symptomatology of autism, addiction, obsessive-compulsive (OCD), and attention deficit/hyperactivity (ADHD) disorders transcends the sphere of motor dysfunction and essentially entails integrative processes under control of prefrontal-thalamic-cerebellar loops. Patients with brain lesions affecting the cortico-striatum thalamic circuitry and the cerebellum indeed exhibit compulsive symptoms. Specifically, lesions of the posterior cerebellar vermis cause affective dysregulation and deficits in executive function. These deficits may be due to impairment of one of the main functions of the cerebellum, implementation of forward internal models of the environment. Actions that are independent of internal models may not be guided by predictive relationships or a mental representation of the goal. In this review article, we explain how this deficit might affect executive functions. Additionally, regionalized cerebellar lesions have been demonstrated to impair other brain functions such as the emergence of habits and behavioral inhibition, which are also altered in compulsive disorders. Similar to the infralimbic cortex, clinical studies and research in animal models suggest that the cerebellum is not required for learning goal-directed behaviors, but it is critical for habit formation. Despite this accumulating data, the role of the cerebellum in compulsive symptomatology and impulsivity is still a matter of discussion. Overall, findings point to a modulatory function of the cerebellum in terminating or initiating actions through regulation of the prefrontal cortices. Specifically, the cerebellum may be crucial for restraining ongoing actions when environmental conditions change by adjusting prefrontal activity in response to the new external and internal stimuli, thereby promoting flexible behavioral control. We elaborate on this explanatory framework and propose a working hypothesis for the involvement of the cerebellum in compulsive and impulsive endophenotypes.
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Affiliation(s)
- Marta Miquel
- Área de Psicobiología, School of Health Science, Universitat Jaume I, Castellón de la Plana, Spain
| | - Saleem M Nicola
- Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, Bronx, NY, United States.,Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Isis Gil-Miravet
- Área de Psicobiología, School of Health Science, Universitat Jaume I, Castellón de la Plana, Spain
| | - Julian Guarque-Chabrera
- Área de Psicobiología, School of Health Science, Universitat Jaume I, Castellón de la Plana, Spain
| | - Aitor Sanchez-Hernandez
- Área de Psicobiología, School of Health Science, Universitat Jaume I, Castellón de la Plana, Spain
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12
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Postnatal N‑acetylcysteine does not provide neuroprotection in extremely low birth weight infants: A follow-up of a randomized controlled trial. Early Hum Dev 2019; 132:13-17. [PMID: 30927687 DOI: 10.1016/j.earlhumdev.2019.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 03/10/2019] [Accepted: 03/18/2019] [Indexed: 11/20/2022]
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13
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Mental health assessed by the Strengths and Difficulties Questionnaire for children born extremely preterm without severe disabilities at 11 years of age: a Norwegian, national population-based study. Eur Child Adolesc Psychiatry 2017; 26:1523-1531. [PMID: 28585081 DOI: 10.1007/s00787-017-1007-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 05/17/2017] [Indexed: 10/19/2022]
Abstract
The aims were to investigate mental health problems with the Strength and Difficulties Questionnaire (SDQ) in children born extremely preterm/extremely low birth weight (EP/ELBW) without severe disabilities compared to controls, and to identify peri-, or neonatal factors possibly predicting later mental health problems. A national Norwegian cohort of 11-year-old EP/ELBW children, excluding those with intellectual disabilities, non-ambulatory cerebral palsy, blindness and/or deafness, was assessed. Parents and teachers completed the SDQ. Mean scores and scores ≥90th percentile for the control group, combined (parent and/or teacher reporting the child ≥90th percentile), and pervasive ratings (both parent and teacher reporting the child ≥90th percentile) were presented. The controls consisted of an unselected population of all 11-year-old children born in 1995 who attended public or private schools in Bergen. Of the eligible children, 216 (64%) EP/ELBW and 1882 (61%) control children participated. The EP/ELBW children had significantly higher scores and/or increased risk of parent, teacher, combined, and pervasive rated hyperactivity/inattention, emotional-, and peer problems (OR 2.1-6.3). Only parents reported the EP/ELBW children to be at an increased risk of conduct problems (OR 1.6, 95% CI 1.1-2.6). Only low maternal education at birth was significantly associated with mental health problems at 11 years of age (OR 2.5, 95% CI 1.2-5.4). EP/ELBW children without severe disabilities had increased risk of symptoms of hyperactivity/inattention, emotional-, and peer problems. None of the peri- or neonatal factors were significantly associated with later mental health problems, except for low maternal education.
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14
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Polić B, Bubić A, Meštrović J, Markić J, Kovačević T, Antončić Furlan I, Utrobičić I, Kolčić I. Emotional and behavioral outcomes and quality of life in school-age children born as late preterm: retrospective cohort study. Croat Med J 2017; 58:332-341. [PMID: 29094811 PMCID: PMC5733375 DOI: 10.3325/cmj.2017.58.332] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Aim To determine the effect of late preterm birth and treatment at the intensive care unit (ICU) on school-age children’s emotional and behavioral problems and quality of life (QoL). Methods Emotional and behavioral problems and QoL were investigated in 6-12-year-olds who were born late preterm at the University Hospital Center Split in the period from January 2002 to March 2008. The study included 126 late preterm children treated in ICU (LP-ICU group), 127 late preterm children not treated in ICU (LP-non-ICU group), and 131 full-term children treated in ICU (FT-ICU group). Emotional and behavioral difficulties were assessed using the Child Behavior Checklist. QoL was evaluated with the Royal Alexandra Hospital for Children Measure of Function questionnaire. The data was collected via telephone interview with mothers during 2014. Results Late preterm children had a nearly 5-fold risk for internalizing problems in comparison with FT-ICU children (OR 4.76, 95% confidence interval [CI] 2.37-9.56 and OR 4.82, 95% CI 2.25-10.37 in LP-ICU and LP-non-ICU children, respectively). They also had a greater risk for externalizing problems (OR 3.08, 95% CI 1.44-6.61 and OR 2.68, 95% CI 1.14-6.28, respectively) and total problems (OR 6.29, 95% CI 2.86-13.83 and OR 7.38, 95% CI 3.08-17.69, respectively) and a considerably increased risk for lower QoL (OR 12.79, 95% CI 5.56-29.41 and OR 5.05, 95% CI 2.04-12.48, respectively). Conclusion Children born late preterm had a greater risk for emotional and behavioral problems and lower QoL during childhood than their full-term born peers and they experienced serious health problems upon birth.
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Affiliation(s)
- Branka Polić
- Branka Polić, Department of Pediatrics, PICU, University Hospital Center Split, Spinčićeva 1, 21000 Split, Croatia,
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15
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Costa DS, Miranda DM, Burnett AC, Doyle LW, Cheong JLY, Anderson PJ. Executive Function and Academic Outcomes in Children Who Were Extremely Preterm. Pediatrics 2017; 140:peds.2017-0257. [PMID: 28853418 DOI: 10.1542/peds.2017-0257] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/13/2017] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Cognitive and behavioral impairments of children born extremely preterm (EP) (<28 weeks' gestation) and extremely low birth weight (ELBW) (<1000 g) may change with age. We assessed the individual stability of behavioral executive function (EF) from 8 to 18 years of age in children born EP or ELBW and their academic outcomes. METHODS Participants comprised 180 children born EP or ELBW from a large geographic cohort. We investigated the frequency of 4 developmental groups (persistent, remitting, late-onset, and typical development) on the basis of dichotomized scores (typical versus elevated) at ages 8 and 18 years in 2 indices (the Behavioral Regulation Index [BRI] and the Metacognition Index [MCI]) of the parental form of the Behavior Rating Inventory of Executive Function. Adolescent academic outcomes were measured by using the word reading, spelling, and math computation subtests of the Wide Range Achievement Test, Fourth Edition. RESULTS Most participants had a typical EF (BRI 61%, MCI 53%), followed by persistent (BRI 15%, MCI 16%), late-onset (BRI 12%, MCI 19%), or remitting (BRI 12%, MCI 13%) executive difficulties. Groups with executive impairments at age 18 years (persistent and late onset) had poorer academic outcomes than the typical and remitting groups. Shifting impairment categories between 8 and 18 years old was relevant to later academic outcomes. CONCLUSIONS Most children showed stable and age-appropriate EF, although persistent and transient difficulties were observed and related to uneven academic outcomes. Studying the origins and consequences of the developmental stability of EF may contribute to the development of interventions to decrease the adverse neurodevelopmental outcomes of preterm birth.
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Affiliation(s)
- Danielle S Costa
- Coordenação de Aperfeiçoamento de Pessoal de Nivel Superior, Ministry of Education of Brazil, Brasília, Brazil
| | - Débora M Miranda
- Department of Pediatrics, Federal University of Minas Gerais, Belo Horizonte, Brazil.,Conselho Nacional de Desenvolvimento Científico e Tecnológico, Ministry of Science, Technology, and Innovation of Brazil, Brasília, Brazil
| | - Alice C Burnett
- Neonatal Services, Royal Women's Hospital, Parkville, Victoria, Australia.,Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Lex W Doyle
- Neonatal Services, Royal Women's Hospital, Parkville, Victoria, Australia.,Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Department of Obstetrics and Gynecology, and.,Department of Pediatrics, Melbourne Medical School, University of Melbourne, Parkville, Victoria, Australia; and
| | - Jeanie L Y Cheong
- Neonatal Services, Royal Women's Hospital, Parkville, Victoria, Australia.,Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Department of Obstetrics and Gynecology, and
| | - Peter J Anderson
- Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria, Australia; .,Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
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16
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Samuelsson M, Holsti A, Adamsson M, Serenius F, Hägglöf B, Farooqi A. Behavioral Patterns in Adolescents Born at 23 to 25 Weeks of Gestation. Pediatrics 2017. [PMID: 28642374 DOI: 10.1542/peds.2017-0199] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND This study examined mental health outcomes in extremely preterm children (EPT) born at 23 to 25 weeks of gestation between 1992 and 1998 at 2 Swedish tertiary care centers that offered regional and active perinatal care to all live-born EPT infants. METHODS We assessed 132 (98%) of the 134 EPT survivors at 10 to 15 years of age alongside term-born controls. Behavioral and emotional problems were evaluated by using Achenbach's Child Behavior Checklist and Teacher Report Form and Conners' Parent and Teacher scales for attention-deficit/hyperactivity disorder. RESULTS Parents and teachers reported significantly more problems with internalizing behaviors as well as attention, social, and thought problems in EPT children than in controls, even when those with major neurodevelopmental disabilities (NDDs) were excluded. Multivariate analysis of covariance of the behavioral problems reported by parents and teachers revealed no interactions, but significant main effects emerged for group status (EPT versus control) and sex, with all effect sizes being medium to large and accounting for 8% to 14% of the variance. Compared with the controls, EPT children without NDDs had significantly increased rates of ≥90th percentile for total Conners' attention-deficit/hyperactivity disorder problem scores (parents: 40% vs 15%, odds ratio: 3.7, P < .001) (teachers: 24% vs 9%, odds ratio: 3.3, P = .005). The corresponding rates were higher in the total population. CONCLUSIONS EPT children with or without NDDs had behavioral problems characterized by a higher risk for anxiety and attention, social, and thought problems. These findings further strengthen the proposition that a preterm behavioral phenotype is recognizable in adolescents born EPT.
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Affiliation(s)
| | | | | | - Fredrik Serenius
- Units of Pediatrics and.,Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Bruno Hägglöf
- Child and Adolescent Psychiatry, Institute of Clinical Sciences, University of Umeå, Umeå, Sweden; and
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17
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Johnson S, Marlow N. Early and long-term outcome of infants born extremely preterm. Arch Dis Child 2017; 102:97-102. [PMID: 27512082 DOI: 10.1136/archdischild-2015-309581] [Citation(s) in RCA: 187] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 07/12/2016] [Indexed: 01/26/2023]
Abstract
There is no question that birth at extremely low gestational ages presents a significant threat to an infant's survival, health and development. Growing evidence suggests that gestational age may be conceptualised as a continuum in which births before 28 weeks of gestation (extremely preterm: EP) represent the severe end of a spectrum of health and developmental adversity. Although comprising just 1%-2% of all births, EP deliveries pose the greatest challenge to neonatal medicine and to health, education and social services for the provision of ongoing support for survivors with additional needs. Studying the outcomes of these infants remains critical for evaluating and enhancing clinical care, planning long-term support and for advancing our understanding of the life-course consequences of immaturity at birth. Here we review literature relating to early and long-term neurodevelopmental, cognitive, behavioural and educational outcomes following EP birth focusing on key themes and considering implications for intervention.
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Affiliation(s)
- Samantha Johnson
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Neil Marlow
- Institute for Women's Health, University College London, London, UK
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18
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Squarza C, Picciolini O, Gardon L, Giannì ML, Murru A, Gangi S, Cortinovis I, Milani S, Mosca F. Learning Disabilities in Extremely Low Birth Weight Children and Neurodevelopmental Profiles at Preschool Age. Front Psychol 2016; 7:998. [PMID: 27445952 PMCID: PMC4923155 DOI: 10.3389/fpsyg.2016.00998] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 06/17/2016] [Indexed: 11/13/2022] Open
Abstract
At school age extremely low birth weight (ELBW) and extremely low gestational age (ELGAN) children are more likely to show Learning Disabilities (LDs) and difficulties in emotional regulation. The aim of this study was to investigate the incidence of LDs at school age and to detect neurodevelopmental indicators of risk for LDs at preschool ages in a cohort of ELBW/ELGAN children with broadly average intelligence. All consecutively newborns 2001-2006 admitted to the same Institution entered the study. Inclusion criteria were BW < 1000 g and/or GA < 28 weeks. Exclusion criteria were severe cerebral injuries, neurosensory disabilities, genetic abnormalities, and/or a Developmental Quotient below normal limits (< 1 SD) at 6 years. The presence of learning disabilities at school age was investigated through a parent-report questionnaire at children's age range 9-10 years. Neurodevelopmental profiles were assessed through the Griffiths Mental Development Scales at 1 and 2 years of corrected age and at 3, 4, 5, and 6 years of chronological age and were analyzed comparing two groups of children: those with LDs and those without. At school age 24 on 102 (23.5%) of our ELBW/ELGAN children met criteria for LDs in one or more areas, with 70.8% comorbidity with emotional/attention difficulties. Children with LDs scored significantly lower in the Griffiths Locomotor and Language subscales at 2 years of corrected age and in the Personal-social, Performance and Practical Reasoning subscales at 5 years of chronological age. Our findings suggest that, among the early developmental indicators of adverse school outcome, there is a poor motor experimentation, language delay, and personal-social immaturity. Cognitive rigidity and poor ability to manage practical situations also affect academic attainment. Timely detection of these early indicators of risk is crucial to assist the transition to school.
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Affiliation(s)
- Chiara Squarza
- NICU, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano Milan, Italy
| | - Odoardo Picciolini
- NICU, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano Milan, Italy
| | - Laura Gardon
- NICU, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano Milan, Italy
| | - Maria L Giannì
- NICU, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano Milan, Italy
| | - Alessandra Murru
- NICU, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano Milan, Italy
| | - Silvana Gangi
- NICU, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano Milan, Italy
| | - Ivan Cortinovis
- Laboratory of Medical Statistics, Biometry and Epidemiology, Department of Clinical Sciences and Community Health, Università degli Studi di Milano Milan, Italy
| | - Silvano Milani
- Laboratory of Medical Statistics, Biometry and Epidemiology, Department of Clinical Sciences and Community Health, Università degli Studi di Milano Milan, Italy
| | - Fabio Mosca
- NICU, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano Milan, Italy
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Fevang SKE, Hysing M, Markestad T, Sommerfelt K. Mental Health in Children Born Extremely Preterm Without Severe Neurodevelopmental Disabilities. Pediatrics 2016; 137:peds.2015-3002. [PMID: 26944946 DOI: 10.1542/peds.2015-3002] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/05/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To describe the prevalence and gender characteristics of mental health problems in extremely preterm/extremely low birth weight (EP/ELBW) children without intellectual disabilities, blindness, deafness, or severe cerebral palsy compared with a reference group at 11 years of age. METHODS In a national cohort of EP/ELBW children, mental health was assessed by parental and teacher report by using the Autism Spectrum Screening Questionnaire, the Swanson, Noland, and Pelham Questionnaire IV (attention-deficit/hyperactivity disorder), the Screen for Child Anxiety Related Emotional Disorders, symptoms of obsessive-compulsive disorder (OCD), and a total difficulties score from the Strength and Difficulties Questionnaire. Pervasive rating was defined as both parent and teacher scoring the child ≥95th percentile (≥90th percentile for total difficulties score) of the reference group, which was the population-based Bergen Child Study. RESULTS Of eligible children, 216 (64%) EP/ELBW and 1882 (61%) reference children participated. EP/ELBW children were at significantly increased risk of pervasive rated symptoms of autism (odds ratio 4.3, 95% confidence interval 2.0-9.3), inattention (8.3, 4.4-15), anxiety (2.3, 1.4-3.7), OCD (2.6, 1.4-3.7), and ≥90th percentile for total difficulties score (4.9, 2.9-8.2). Reported by either parents or teachers, 54% of the EP/ELBW and 21% of the reference children had ≥1 mental health problem (odds ratio 4.5, 95% confidence interval 3.3-6.1). There were no significant interactions between EP/ELBW and gender in mental health outcomes. CONCLUSIONS EP/ELBW children without severe disabilities had increased risk of symptoms of autism, inattention, anxiety, and OCD. Gender differences were comparable to the reference group.
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Affiliation(s)
- Silje Katrine Elgen Fevang
- Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway; Department of Pediatrics, Haukeland University Hospital, Bergen, Norway; and
| | - Mari Hysing
- Uni Research Health, Regional Centre for Child and Youth Mental Health and Child Welfare, Bergen, Norway
| | - Trond Markestad
- Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway; Department of Pediatrics, Haukeland University Hospital, Bergen, Norway; and
| | - Kristian Sommerfelt
- Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway; Department of Pediatrics, Haukeland University Hospital, Bergen, Norway; and
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Executive Functioning and Learning Skills of Adolescent Children Born at Fewer than 26 Weeks of Gestation. PLoS One 2016; 11:e0151819. [PMID: 26999522 PMCID: PMC4801389 DOI: 10.1371/journal.pone.0151819] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 03/06/2016] [Indexed: 11/25/2022] Open
Abstract
Aims To assess the cognitive and behavioral aspects of executive functioning (EF) and learning skills in extremely preterm (EPT) children compared with term control children aged 10 to 15 years. Methods A total of 132 of 134 (98% of all eligible survivors) EPT children born at the 2 Swedish regional tertiary care centers from 1992 to 1998 (mean age = 12 years, mean birth weight = 718 g, and mean gestational age = 24.4 weeks) and 103 matched term controls were assessed. General intelligence was assessed using the Wechsler Intelligence Scale for Children (WISC-III-R), and cognitive aspects of EF were analyzed using EF-sensitive subscales of the WISC-III-R and Tower test of the Delis-Kaplan Executive Function Scale (D-KEFS). Behaviors related to EF and learning skills were assessed using the Five to Fifteen questionnaire, which is a validated parent and teacher instrument. Academic performance in school was assessed by teachers’ responses on Achenbach’s Teachers Report Form. Analyses performed included multivariate analyses of covariance (ANCOVA and MANCOVA) and logistic regression analyses. Results The EPT children displayed significant deficits in cognitive aspects of EF compared with the controls, exhibiting decreases on the order of 0.9 SD to 1.2 SD for tasks of verbal conceptual reasoning, verbal and non-verbal working memory, processing speed and planning ability (P <0.001 for all). After excluding the children with major neurosensory impairment (NSI) or a Full Scale intelligence quotient (FSIQ) of < 70, significant differences were observed on all tests. Compared with controls, parents and teachers of EPT children reported significantly more EF-related behavioral problems. MANCOVA of teacher-reported learning skills in children with FSIQ >70 and without major NSI revealed no interactions, but significant main effects were observed for the behavioral composite executive function score, group status (EPT vs control) and FSIQ, for which all effect sizes were medium to large. The corresponding findings of MANCOVA of the parent-reported learning skills were very similar. According to the teachers’ ratings, the EPT children were less well adjusted to the school environment. Conclusion EPT children born in the 1990s who received active perinatal care are at an increased risk of executive dysfunction, even after excluding children with significant neurodevelopmental disabilities. Even mild to moderate executive dysfunctions has a significant impact on learning skills. These findings suggest the need for timely interventions that address specific cognitive vulnerabilities and executive dysfunctions.
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Leijon I, Ingemansson F, Nelson N, Wadsby M, Samuelsson S. Reading deficits in very low birthweight children are associated with vocabulary and attention issues at the age of seven. Acta Paediatr 2016; 105:60-8. [PMID: 26098907 PMCID: PMC4758409 DOI: 10.1111/apa.13094] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Revised: 03/30/2015] [Accepted: 06/16/2015] [Indexed: 01/17/2023]
Abstract
Aim This Swedish study compared reading skills between seven‐year‐old children with a very low birthweight (VLBW) and controls with a normal birthweight, exploring associations between reading variables and cognition, parent‐rated behaviour, perinatal factors and family factors. Methods We studied 51 VLBW children, with no major neurodevelopmental impairments and attending their first year at a regular school, and compared them with the 51 sex‐ and age‐matched controls. The test battery, carried out at 7.8 ± 0.4 years of age, included reading skills, the Wechsler Intelligence Scale for Children – III and the Child Behaviour Checklist. Results Very low birthweight children with a mean birthweight of 1105 g (±291 g) and a gestational age of 28.8 (±2.2) weeks scored significantly lower in all reading subtests and cognition and demonstrated more behavioural problems than normal birthweight controls. We also found significant associations between poor vocabulary, combined with attention problems, and phonological awareness, rapid naming and spelling control. Perinatal factors had no association with reading function, and socio‐economic factors had very few. Conclusion Very low birthweight children demonstrated deficits in all reading domains and had poorer cognition and more behavioural problems at the age of seven, with reading ability related to vocabulary and attention.
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Affiliation(s)
- Ingemar Leijon
- Department of Clinical and Experimental Medicine, Paediatrics Linköping University Linköping Sweden
| | - Fredrik Ingemansson
- Department of Paediatrics Ryhov County Hospital Jönköping Sweden
- Department of Clinical and Experimental Medicine Linköping University Linköping Sweden
| | - Nina Nelson
- Department of Clinical and Experimental Medicine, Paediatrics Linköping University Linköping Sweden
- Department of Quality and Patient Safety Karolinska University Hospital Stockholm Sweden
| | - Marie Wadsby
- Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry Linköping University Linköping Sweden
| | - Stefan Samuelsson
- Department of Behavioural Sciences and Learning Linköping University Linköping Sweden
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22
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Koivisto A, Klenberg L, Tommiska V, Lano A, Laine M, Fellman V, Haavisto A. Parents tend to underestimate cognitive deficits in 10- to 13-year-olds born with an extremely low birth weight. Acta Paediatr 2015; 104:1182-8. [PMID: 26081165 DOI: 10.1111/apa.13087] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 04/18/2015] [Accepted: 06/12/2015] [Indexed: 11/30/2022]
Abstract
AIM This study determined the cognitive outcomes of Finnish children born with an extremely low birth weight (ELBW) and assessed the agreement between their neuropsychological assessment and how their parents evaluated their cognitive difficulties. METHODS The study focused on 121 children from an ELBW cohort with a mean age of 11.6 years (range 10.3-13.8) and assessed them using a standardised test of intelligence, a neuropsychological test battery and a parental developmental questionnaire. The results were compared with the test norms. RESULTS ELBW children exhibited global cognitive impairment compared to the test norms, with no differences between children who were small or appropriate for gestational age. Children with average intelligence displayed specific impairment in executive, sensorimotor and visuospatial functions. Corresponding functions in the parental evaluation and neuropsychological assessment were associated, but 16-26% of children scoring under the clinical cut-off value in the neuropsychological test domains were not detected by the parental evaluations. CONCLUSION Children born with an ELBW faced a high risk of global cognitive impairment at a mean age of 11.6 years, and those with average intelligence were at risk of specific cognitive sequelae. Compared to the neuropsychological tests, up to one-fourth of the parents underestimated their child's cognitive problems.
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Affiliation(s)
- Annika Koivisto
- Department of Psychology; Åbo Akademi University; Turku Finland
| | - Liisa Klenberg
- Institute of Behavioural Sciences; University of Helsinki; Helsinki Finland
| | - Viena Tommiska
- Children's Hospital; Helsinki University Central Hospital; University of Helsinki; Helsinki Finland
| | - Aulikki Lano
- Children's Hospital; Helsinki University Central Hospital; University of Helsinki; Helsinki Finland
| | - Matti Laine
- Department of Psychology; Åbo Akademi University; Turku Finland
| | - Vineta Fellman
- Children's Hospital; Helsinki University Central Hospital; University of Helsinki; Helsinki Finland
- Department of Clinical Sciences, Pediatrics; Lund University; Lund Sweden
| | - Anu Haavisto
- Institute of Behavioural Sciences; University of Helsinki; Helsinki Finland
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Lambek R, Trillingsgaard A. Elaboration, validation and standardization of the five to fifteen (FTF) questionnaire in a Danish population sample. RESEARCH IN DEVELOPMENTAL DISABILITIES 2015; 38:161-170. [PMID: 25590170 DOI: 10.1016/j.ridd.2014.12.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 12/09/2014] [Indexed: 06/04/2023]
Abstract
The five to fifteen (FTF) is a parent questionnaire developed to assess ADHD, its common comorbid conditions and associated problems in children and adolescents. The present study examined (1) the psychometric properties of scores on the new teacher version of the FTF, (2) competing models of the FTF subdomain structure and (3) the psychometric properties and utility of scores on the newly developed FTF impact questions. Parents (n=4258) and teachers (n=1298) of Danish children and adolescents (ages 5 to 17 years), selected using simple random sampling, completed the FTF. In the largest study of the FTF to date, parent and teacher scores had acceptable psychometric properties. The FTF subdomains were organized into six domains labelled cognitive skills, motor/perception, emotion/socialization/behaviour, attention, literacy skills and activity control and analysis of these domains may provide additional information when applying the FTF in the future. The impact questions yielded information above and beyond that provided by symptom count alone and appeared to increase the ability of the FTF to identify at risk children and adolescents.
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Affiliation(s)
- Rikke Lambek
- Department of Psychology, Aarhus University, Bartholins Allé 9, 8000 Aarhus C, Denmark.
| | - Anegen Trillingsgaard
- Department of Psychology, Aarhus University, Bartholins Allé 9, 8000 Aarhus C, Denmark
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Illum NO, Gradel KO. The Nordic Five to Fifteen questionnaire could provide the basis for a common neurological disability variable. Acta Paediatr 2014; 103:879-85. [PMID: 24799045 DOI: 10.1111/apa.12675] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Revised: 02/21/2014] [Accepted: 04/28/2014] [Indexed: 11/30/2022]
Abstract
AIMS Assessing disabilities in children is essential and Danish parents provide increasingly important feedback on how their child's disability affects daily living. The Nordic Five to Fifteen (FTF) parent questionnaire is widely used in Nordic countries to detect atypical or delayed development in children. Our study evaluated its internal validity and whether it could be used to generate a common disability variable across childhood neurological disorders and severities. METHODS The 28-statement FTF questionnaire was completed by the parents of children with spina bifida, muscular disorders, spinal atrophy, cerebral palsy, blindness, deafness, mental retardation and disability, who received treatment for brain tumours. Psychometric analysis and Rasch analysis of the five FTF code qualifier level data were carried out. RESULTS A total of 227 of 332 (68.4%) parents participated. The mean qualifier score was 3.06 (standard deviation 0.89, range 2.31-4.26), and the variances mean was 1.57 (range 0.87-2.38). The corrected code-total correlation was 0.65, and reliability was 0.96. The Rasch analysis demonstrated good fit alignment of codes. CONCLUSION The FTF questionnaire can be used with children with neurological disabilities, and the Rasch scale analysis results indicate that it could form the analytical basis for developing a common disability variable.
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Affiliation(s)
- Niels Ove Illum
- H. C. Andersen Children's Hospital; Division of Child Neurology; Odense University Hospital; Odense Denmark
| | - Kim Oren Gradel
- Centre for Clinical Epidemiology; Odense University Hospital and Research Unit of Clinical Epidemiology; Institute of Clinical Research; University of Southern Denmark; Odense Denmark
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Smith AL, Hill CA, Alexander M, Szalkowski CE, Chrobak JJ, Rosenkrantz TS, Fitch RH. Spatial working memory deficits in male rats following neonatal hypoxic ischemic brain injury can be attenuated by task modifications. Brain Sci 2014; 4:240-72. [PMID: 24961760 PMCID: PMC4101476 DOI: 10.3390/brainsci4020240] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Revised: 01/22/2014] [Accepted: 03/18/2014] [Indexed: 12/19/2022] Open
Abstract
Hypoxia-ischemia (HI; reduction in blood/oxygen supply) is common in infants with serious birth complications, such as prolonged labor and cord prolapse, as well as in infants born prematurely (<37 weeks gestational age; GA). Most often, HI can lead to brain injury in the form of cortical and subcortical damage, as well as later cognitive/behavioral deficits. A common domain of impairment is working memory, which can be associated with heightened incidence of developmental disorders. To further characterize these clinical issues, the current investigation describes data from a rodent model of HI induced on postnatal (P)7, an age comparable to a term (GA 36–38) human. Specifically, we sought to assess working memory using an eight-arm radial water maze paradigm. Study 1 used a modified version of the paradigm, which requires a step-wise change in spatial memory via progressively more difficult tasks, as well as multiple daily trials for extra learning opportunity. Results were surprising and revealed a small HI deficit only for the final and most difficult condition, when a delay before test trial was introduced. Study 2 again used the modified radial arm maze, but presented the most difficult condition from the start, and only one daily test trial. Here, results were expected and revealed a robust and consistent HI deficit across all weeks. Combined results indicate that male HI rats can learn a difficult spatial working memory task if it is presented in a graded multi-trial format, but performance is poor and does not appear to remediate if the task is presented with high initial memory demand. Male HI rats in both studies displayed impulsive characteristics throughout testing evidenced as reduced choice latencies despite more errors. This aspect of behavioral results is consistent with impulsiveness as a core symptom of ADHD—a diagnosis common in children with HI insult. Overall findings suggest that task specific behavioral modifications are crucial to accommodating memory deficits in children suffering from cognitive impairments following neonatal HI.
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Affiliation(s)
- Amanda L Smith
- Behavioral Neuroscience Division, Department of Psychology, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT 06269, USA.
| | - Courtney A Hill
- Behavioral Neuroscience Division, Department of Psychology, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT 06269, USA.
| | - Michelle Alexander
- Division of Neonatology, Department of Pediatrics, University of Minnesota, 516 Delaware Street S.E. Minneapolis, MN 55454, USA.
| | - Caitlin E Szalkowski
- Behavioral Neuroscience Division, Department of Psychology, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT 06269, USA.
| | - James J Chrobak
- Behavioral Neuroscience Division, Department of Psychology, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT 06269, USA.
| | - Ted S Rosenkrantz
- Department of Pediatrics, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030, USA.
| | - R Holly Fitch
- Behavioral Neuroscience Division, Department of Psychology, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT 06269, USA.
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