Social development of children born very preterm: a systematic review

Screening preterm-born infants for autistic traits may help to identify social communication difficulties at five years of age

AIM

This study compared neurodevelopmental screening questionnaires completed when preterm-born children reached 2 years of corrected age with social communication skills at 5.5 years of age.

METHODS

Eligible subjects were born in 2011 at 24-34 weeks of gestation, participated in a French population-based epidemiological study and were free of motor and sensory impairment at 2 years of corrected age. The Ages and Stages Questionnaire (ASQ) and the Modified Checklist for Autism in Toddlers (M-CHAT) were used at 2 years and the Social Communication Questionnaire (SCQ) at 5.5 years of age.

RESULTS

We focused on 2119 children. At 2 years of corrected age, the M-CHAT showed autistic traits in 20.7%, 18.5% and 18.2% of the children born at 24-26, 27-31 and 32-34 weeks of gestation, respectively (p = 0.7). At 5.5 years of age, 12.6%, 12.7% and 9.6% risked social communication difficulties, with an SCQ score ≥90th percentile (p = 0.2). A positive M-CHAT score at 2 years was associated with higher risks of social communication difficulties at 5.5 years of age (odds ratio 3.46, 95% confidence interval 2.04-5.86, p < 0.001). Stratifying ASQ scores produced similar results.

CONCLUSION

Using parental neurodevelopmental screening questionnaires for preterm-born children helped to identify the risk of later social communication difficulties.

The early educational environment at five years of age in a European cohort of children born very preterm: challenges and opportunities for research

BACKGROUND

Early childhood education offers opportunities for stimulation in multiple developmental domains and its positive impact on long-term outcomes and wellbeing for children is well documented. Few studies have explored early education in children born very preterm (VPT; <32 weeks of gestation) who are at higher risk of neurodevelopmental disorders and poor educational outcomes than their term-born peers. The purpose of the study is to describe and compare the educational environment of children born VPT in European countries at 5 years of age according to the degree of perinatal risk.

METHODS

Data originated from the population-based Screening to Improve Health In very Preterm infants (SHIPS) cohort of children born VPT in 2011/2012 in 19 regions from 11 European countries. Perinatal data were collected from medical records and the 5-year follow-up was conducted using parental questionnaires. Outcomes at 5 years were participation in early education (any, type, intensity of participation) and receipt of special educational support, which were harmonized across countries.

RESULTS

Out of 6,759 eligible children, 3,687 (54.6%) were followed up at 5 years (mean gestational age 29.3 weeks). At 5 years, almost all children (98.6%) were in an educational program, but type (preschool/primary), attendance (full-time/part-time) and use and type of school support/services differed by country. In some countries, children with high perinatal risk were more likely to be in full-time education than those with low risk (e.g. Estonia: 97.9% vs. 87.1%), while the inverse pattern was observed elsewhere (e.g. Poland: 78.5% vs. 92.8%). Overall, 22.8% of children received special educational support (country range: 12.4-34.4%) with more support received by children with higher perinatal risk. Large variations between countries remained after adjustment for socio-demographic characteristics.

CONCLUSIONS

There are marked variations in approaches to early education for children born VPT in Europe, raising opportunities to explore its impact on their neurodevelopment and well-being.

Exploring early life social and executive function development in infants and risk for autism: a prospective cohort study protocol of NICU graduates and infants at risk for cerebral palsy

BACKGROUND

Delays in early social and executive function are predictive of later developmental delays and eventual neurodevelopmental diagnoses. There is limited research examining such markers in the first year of life. High-risk infant groups commonly present with a range of neurodevelopmental challenges, including social and executive function delays, and show higher rates of autism diagnoses later in life. For example, it has been estimated that up to 30% of infants diagnosed with cerebral palsy (CP) will go on to be diagnosed with autism later in life.

METHODS

This article presents a protocol of a prospective longitudinal study. The primary aim of this study is to identify early life markers of delay in social and executive function in high-risk infants at the earliest point in time, and to explore how these markers may relate to the increased risk for social and executive delay, and risk of autism, later in life. High-risk infants will include Neonatal Intensive Care Unit (NICU) graduates, who are most commonly admitted for premature birth and/or cardiovascular problems. In addition, we will include infants with, or at risk for, CP. This prospective study will recruit 100 high-risk infants at the age of 3-12 months old and will track social and executive function across the first 2 years of their life, when infants are 3-7, 8-12, 18 and 24 months old. A multi-modal approach will be adopted by tracking the early development of social and executive function using behavioural, neurobiological, and caregiver-reported everyday functioning markers. Data will be analysed to assess the relationship between the early markers, measured from as early as 3-7 months of age, and the social and executive function as well as the autism outcomes measured at 24 months.

DISCUSSION

This study has the potential to promote the earliest detection and intervention opportunities for social and executive function difficulties as well as risk for autism in NICU graduates and/or infants with, or at risk for, CP. The findings of this study will also expand our understanding of the early emergence of autism across a wider range of at-risk groups.

Sex Differences in Autistic Youth Born Extremely Preterm

PURPOSE

To evaluate sex differences in autistic traits in youth born extremely preterm (EP; 23-27 weeks) who were later diagnosed with autism spectrum disorder (ASD) at 10-years.

METHOD

A longitudinal cohort design from the Extremely Low Gestational Age Newborn Study (ELGAN) followed N = 857 EP infants from birth through 10-years. EP infants later diagnosed with ASD (N = 61, 20 females) participated in the study. Group differences were evaluated via inferential and Bayesian statistics (values > 1 suggest evidence for alternate hypothesis) on ASD screeners (M-CHAT at 2-years, SCQ and SRS-2 at 10-years), and gold-standard diagnostic measures (ADOS-2, ADI-R) at 10-years.

RESULTS

Males scored significantly higher than females on measures of Social Affect from the ADOS-2, t(34.27)=-2.20, BF10 = 2.33, and measures of Repetitive and Restricted Behaviors from the ADI-R, t(40.52)=-2.85, BF10 = 5.26. Bayesian estimates suggested marginal evidence for sex differences in Nonverbal Communication, t(30.66)=-1.81, BF10 = 1.25, and Verbal Communication, t(24.64)=-1.89, BF10 = 1.39, from the ADI-R, wherein males scored higher than females. No statistically significant sex differences were identified on any of the ASD screeners at 2 (M-CHAT) or 10 years (SCQ). No significant sex differences were observed on any subscales of the SRS at 10 years.

CONCLUSIONS

EP autistic males present with more autistic traits than EP autistic females on gold-standard diagnostic measures of autism at 10-years of age, despite not presenting with higher autistic traits on screeners at either age. These results align with sex differences observed in full-term, autistic youth. These results suggest ASD screeners may under identify autism in EP youth, particularly females.

Subtle microstructural alterations in white matter tracts involved in socio-emotional processing after very preterm birth

Children born very preterm (VPT, < 32 weeks of gestation) have an increased risk of developing socio-emotional difficulties. Possible neural substrates for these socio-emotional difficulties are alterations in the structural connectivity of the social brain due to premature birth. The objective of the current study was to study microstructural white matter integrity in VPT versus full-term (FT) born school-aged children along twelve white matter tracts involved in socio-emotional processing. Diffusion MRI scans were obtained from a sample of 35 VPT and 38 FT 8-to-12-year-old children. Tractography was performed using TractSeg, a state-of-the-art neural network-based approach, which offers investigation of detailed tract profiles of fractional anisotropy (FA). Group differences in FA along the tracts were investigated using both a traditional and complementary functional data analysis approach. Exploratory correlations were performed between the Social Responsiveness Scale (SRS-2), a parent-report questionnaire assessing difficulties in social functioning, and FA along the tract. Both analyses showed significant reductions in FA for the VPT group along the middle portion of the right SLF I and an anterior portion of the left SLF II. These group differences possibly indicate altered white matter maturation due to premature birth and may contribute to altered functional connectivity in the Theory of Mind network which has been documented in earlier work with VPT samples. Apart from reduced social motivation in the VPT group, there were no significant group differences in reported social functioning, as assessed by SRS-2. We found that in the VPT group higher FA values in segments of the left SLF I and right SLF II were associated with better social functioning. Surprisingly, the opposite was found for segments in the right IFO, where higher FA values were associated with worse reported social functioning. Since no significant correlations were found for the FT group, this relationship may be specific for VPT children. The current study overcomes methodological limitations of previous studies by more accurately segmenting white matter tracts using constrained spherical deconvolution based tractography, by applying complementary tractometry analysis approaches to estimate changes in FA more accurately, and by investigating the FA profile along the three components of the SLF.

Play brick therapy to aid the social skills of children and young people with autism spectrum disorder: the I-SOCIALISE cluster RCT

Background

Social skills interventions are commonly recommended to help children and young people with autism spectrum disorder develop social skills, but some struggle to engage in these interventions. LEGO® (LEGO System A/S, Billund, Denmark) based therapy, a group social skills intervention, aims to be more interesting and engaging.

Objective

To evaluate the clinical effectiveness of LEGO® based therapy on the social and emotional skills of children and young people with autism spectrum disorder in school settings compared with usual support. Secondary objectives included evaluations of cost-effectiveness, acceptability and treatment fidelity.

Design

A cluster randomised controlled trial randomly allocating participating schools to either LEGO® based therapy and usual support or usual support only.

Setting

Mainstream schools in the north of England.

Participants

Children and young people (aged 7-15 years) with autism spectrum disorder, their parent/guardian, an associated teacher/teaching assistant and a facilitator teacher/teaching assistant (intervention schools only).

Intervention

Schools randomised to the intervention arm delivered 12 weekly sessions of LEGO® based therapy, which promotes collaborative play and encourages social problem-solving in groups of three children and young people with a facilitator (trained teacher or teaching assistant). Participants received usual support from school and community services. Participants in the control arm received usual support only. Research assistants and statisticians were blind to treatment allocation.

Main outcome measure

The social skills subscale of the Social Skills Improvement System (SSIS), completed by the children and young people's unblinded teacher pre randomisation and 20 weeks post randomisation. The SSIS social skills subscale measures social skills including social communication, co-operation, empathy, assertion, responsibility and self-control. Participants completed a number of other pre- and post-randomisation measures of emotional health, quality of life, loneliness, problem behaviours, academic competence, service resource utilisation and adverse events.

Results

A total of 250 children and young people from 98 schools were randomised: 127 to the intervention arm and 123 to the control arm. Intention-to-treat analysis of the main outcome measure showed a modest positive difference of 3.74 points (95% confidence interval -0.16 to 7.63 points, standardised effect size 0.18; p = 0.06) in favour of the intervention arm. Statistical significance increased in per-protocol analysis, with a modest positive difference (standardised effect size 0.21; p = 0.036). Cost-effectiveness of the intervention was found in reduced service use costs and a small increase in quality-adjusted life-years. Intervention fidelity and acceptability were positive. No intervention-related adverse events or effects were reported.

Conclusions

The primary and pre-planned sensitivity analysis of the primary outcome consistently showed a positive clinical difference, with modest standardised effect sizes of between 0.15 and 0.21. There were positive health economics and qualitative findings, corroborated by the difference between arms for the majority of secondary outcomes, which were not statistically significant but favoured the intervention arm. Post hoc additional analysis was exploratory and was not used in drawing this conclusion. Given the small positive change, LEGO® based therapy for children and young people with autism spectrum disorder in schools should be considered.

Limitations

The primary outcome measure was completed by an unblinded teacher (rather than by the facilitator).

Future work

The study team recommends future research into LEGO® based therapy, particularly in school environments.

Trial registration

This trial is registered as ISRCTN64852382.

Funding

This award was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: 15/49/32) and is published in full in Public Health Research; Vol. 11, No. 12. See the NIHR Funding and Awards website for further award information.

Risk profiles of the preterm behavioral phenotype in children aged 3 to 18 years

Objective

Characterize the Preterm Behavioral Phenotype in children born preterm by identifying distinct profiles based on patterns of symptomatology or severity of the risk for attention-deficit/hyperactivity disorder, autism spectrum disorder, and anxiety, and determine their associations with child sex, gestational age, and chronological age.

Methods

Sample comprised 2,406 children born preterm aged 3-18 years with primary caregiver behavioral ratings on the standardized Strengths and Weaknesses of ADHD Symptoms and Normal Behavior Scale, Social Responsiveness Scale, and Preschool Anxiety Scale or Screen for Child Anxiety and Related Emotional Disorders.

Results

Statistical fit indices of latent profile analysis supported a 3-profile model as optimal. Using this model, 75% of children born preterm were identified as having low expression, 20% moderate expression, and 5% high expression profiles of the Preterm Behavioral Phenotype described as co-occurring symptomatology of attention-deficit/hyperactivity disorder, autism spectrum disorder, and anxiety. Male children were more likely than females to be categorized in the moderate expression [Relative Risk Ratio (RRR) = 1.29, 95% CI = 1.05-1.59], and high expression profiles (RRR = 1.77, 95% CI = 1.17-2.66). Children born extremely preterm were more likely than those born moderate/late preterm to be categorized in the moderate expression (RRR = 1.68, 95% CI = 1.30-2.19) and high expression profiles (RRR = 2.06, 95% CI = 1.31-3.25). Finally, those in the school-age (RRR = 1.68, 95% CI = 1.32-2.14; RRR = 1.95, 95% CI = 1.21-3.13), early adolescence (RRR = 1.85, 95% CI = 1.38-2.48; RRR = 2.61, 95% CI = 1.53-4.44) and late adolescence (RRR = 2.09, 95% CI = 1.38-3.19; RRR = 2.28, 95% CI = 1.02-5.08) periods were more likely than those in the preschool period to be categorized in the moderate and high expression profiles, respectively.

Conclusion

A quarter of children born preterm were at elevated risk for manifesting symptomatology across all three domains of the Preterm Behavioral Phenotype. Findings emphasize accounting for symptom co-occurrence of this phenotype in neurodevelopmental follow-up and psychosocial interventions to optimize child outcomes.

Symptoms and antecedents of autism in children born extremely premature: a national population-based study

The objective of this study is to investigate the prevalence of autism (ASD) symptoms, i.e. , social difficulties, repetitive behaviors, and communicational problems, among children born extremely preterm (EP) compared to a reference group, and to investigate possible antecedents of ASD symptoms among EP children. Method is a national Norwegian cohort of 11 year old EP children, excluding those with intellectual disabilities, non-ambulatory cerebral palsy, blindness, and/or deafness. Parents and teachers reported ASD symptoms using The Autism Spectrum Screening Questionnaire (ASSQ). Social difficulties, repetitive behaviors, communicational problems, and a total ASSQ score were presented. Combined ratings on the ASSQ was defined as parent and/or teacher scoring the child ≥ 98th percentile of the reference group, which was the population-based Bergen Child Study. Of eligible children, 216 (64%) EP and 1882 (61%) reference children participated. EP children had significantly higher mean scores and combined ratings on social difficulties (14.5% vs. 4.1%, OR: 3.2), repetitive behaviors (23.7% vs. 4.0%, OR: 6.4), communicational problems (23.1% vs. 4.8%, OR: 5.4), and the total ASSQ score (18.3% vs. 3.4%, OR: 5.7) compared to reference children. Only no prenatal steroids, IQ 70-84, and mental health problems at 5 years of age were significantly associated with ASD symptoms at 11 years of age. EP children were at increased risk of social difficulties, repetitive behaviors, and communicational problems, and approximately one out of five were reported as high scorers of ASD symptoms. No prenatal steroids use, IQ in the lower range, and mental health problems at 5 years of age were associated with ASD symptoms.

Parenting Interventions Targeting Behavior for Children Born Preterm or Low Birth Weight: A Systematic Review

OBJECTIVE

To systematically review and summarize the outcomes of parenting interventions designed to improve child and/or parenting behavior for children born preterm and/or low birth weight (LBW).

METHODS

We conducted systematic searches of Embase, Scopus, PubMed, PsycInfo, and CINAHL in September 2021. We identified articles published at any time that describe the outcomes of parenting interventions targeting the child and/or parenting behavior of children born preterm/LBW and their caregivers. Two independent raters assessed the risk of bias using the Revised Cochrane Risk-of-Bias Tool.

RESULTS

Eight hundred sixteen titles and abstracts were screened, followed by 71 full-text articles, resulting in 24 eligible articles reporting on nine interventions with 1,676 participants. Eligible articles had an adequate risk of bias ratings. Sample characteristics, intervention components, and intervention effects were tabulated and described narratively by the intervention type. Preventative and treatment programs demonstrated positive intervention effects on externalizing behavior, parenting stress, and parenting behaviors, with mixed effects on internalizing behavior and emotion regulation. The few studies with longitudinal follow-up found little evidence of effects beyond 6 months postintervention.

CONCLUSION

Behavior problems in children born preterm/LBW may be modifiable, and interventions targeting parenting behavior are promising. However, existing interventions may not produce long-lasting changes and are not designed for children older than four. Existing treatment programs may require adaptation for the neurocognitive, medical, and family needs of children born preterm/LBW (e.g., processing speed deficits, post-traumatic stress). Interventions that account for theories of sustained change may promote long-term effectiveness and the developmental tailoring of parenting skills.

Cross-modal coherence and incoherence of early infant interactive behavior: links to attachment in infants born very preterm or full-term

Infants exhibit flexibly organized configurations of facial, vocal, affective, and motor behavior during caregiver-infant interactions that convey convergent messages about their internal states and desires. Prior work documents that greater cross-modal discrepancy at 4 months predicts disorganized attachment. Here, we evaluated whether: very preterm (VPT) or full-term (FT) status predicts cross-modal coherence or incoherence in infants' behavior with the caregiver at 3 months; and, regardless of prematurity, whether cross-modal interactive coherence or incoherence predicts 12-month attachment. Participants included 155 infants (85 FT; 70 VPT), and their mothers followed from birth to 12 months (corrected age). Infants' cross-modal coherent and incoherent responses were scored microanalytically from videotaped en-face interactions. Infants' attachment security was evaluated during Ainsworth's Strange Situation. Infants born VPT exhibited more incoherent cross-modal responses and insecure attachment than infants born FT. Regardless of prematurity, infants' coherent and incoherent cross-modal interactive behaviors at 3 months predicted different attachment patterns at 12 months.

Within- and between-twin comparisons of risk for childhood behavioral difficulties after preterm birth

BACKGROUND

Preterm birth and multiple gestation are independently associated with adverse neurodevelopmental outcomes. The objective of this study was to describe risks of screening positive for attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and anxiety in preterm-born twin children by zygosity (monozygotic, dizygotic) and birth order (first-born, second-born).

METHODS

Caregivers of 349 preterm-born twin pairs (42% monozygotic) aged 3-18 years reported child behavioral outcomes on Strengths and Weaknesses of ADHD Symptoms and Normal Behavior; Social Responsiveness Scale, Second Edition; and Preschool Anxiety Scale or Screen for Child Anxiety and Related Emotional Disorders.

RESULTS

Concordance for behavioral outcomes in twin pairs ranged from 80.06 to 89.31% for ADHD, 61.01 to 84.23% for ASD, and 64.76 to 73.35% for anxiety. Monozygotic twins had a greater risk than dizygotic of screening positive for inattention (risk ratio = 2.91, 95% CI = 1.48-5.72) and social anxiety (1.79, 1.23-2.61). Relative to first-born, second-born twins had a greater risk of screening positive for hyperactivity/impulsivity (1.51, 1.06-2.16); overall ASD (2.38, 1.62-3.49); difficulties with social awareness (2.68, 1.94-3.71), social cognition (4.45, 3.06-6.46), and social communication (2.36, 1.56-3.57); restricted/repetitive behavior (1.91, 1.30-2.81); overall anxiety (1.34, 1.10-1.64); generalized anxiety (1.34, 1.11-1.60); and social anxiety (1.32, 1.06-1.64).

CONCLUSION

The current findings emphasize considering zygosity and birth order in preterm and multiple birth outcomes research, and highlight clinical implications for discharge planning, neurodevelopmental surveillance, and facilitating parenting and family support.

IMPACT

Zygosity and birth order are important determinants of behavioral and socioemotional outcomes in preterm-born twins. Among 349 preterm-born twin pairs aged 3-18 years (42% monozygotic), 61-89% demonstrated concordance for behavioral and socioemotional outcomes. Monozygosity had greater risks than dizygosity for positive screening of inattention and social anxiety. Second-born twins had greater risks than first-born for hyperactivity/impulsivity, social difficulties (awareness, cognition, communication), restricted/repetitive behavior, and anxiety (generalized, social). These findings have implications for discharge planning, neurodevelopmental surveillance, and facilitating parenting and family support.

Social Safety Theory: Conceptual foundation, underlying mechanisms, and future directions

Classic theories of stress and health are largely based on assumptions regarding how different psychosocial stressors influence biological processes that, in turn, affect human health and behavior. Although theoretically rich, this work has yielded little consensus and led to numerous conceptual, measurement, and reproducibility issues. Social Safety Theory aims to address these issues by using the primary goal and regulatory logic of the human brain and immune system as the basis for specifying the social-environmental situations to which these systems should respond most strongly to maximize reproductive success and survival. This analysis gave rise to the integrated, multi-level formulation described herein, which transforms thinking about stress biology and provides a biologically based, evolutionary account for how and why experiences of social safety and social threat are strongly related to health, well-being, aging, and longevity. In doing so, the theory advances a testable framework for investigating the biopsychosocial roots of health disparities as well as how health-relevant biopsychosocial processes crystalize over time and how perceptions of the social environment interact with childhood microbial environment, birth cohort, culture, air pollution, genetics, sleep, diet, personality, and self-harm to affect health. The theory also highlights several interventions for reducing social threat and promoting resilience.

A Comparison of the Clinical Presentation of Preterm Birth and Autism Spectrum Disorder: Commonalities and Distinctions in Children Under 3

Premature infants and infants later diagnosed with autism spectrum disorder (ASD) share many commonalities in clinical presentations. However, prematurity and ASD also have differences in clinical presentation. These overlapping phenotypes can lead to misdiagnoses of ASD or missing a diagnosis of ASD in preterm infants. We document these commonalities and differences in various developmental domains with the hope of aiding in the accurate early detection of ASD and timely intervention implementation in children born premature. Given the degree of similarities in presentation, evidence-based interventions designed specifically for preterm toddlers or toddlers with ASD may ultimately aid both populations.

Behavioral outcome of very preterm children at 5 years of age: Prognostic utility of brain tissue volumes at term-equivalent-age, perinatal, and environmental factors

OBJECTIVE

Prematurity is associated with a high risk of long-term behavioral problems. This study aimed to assess the prognostic utility of volumetric brain data at term-equivalent-age (TEA), clinical perinatal factors, and parental social economic risk in the prediction of the behavioral outcome at 5 years in a cohort of very preterm infants (VPT, <32 gestational weeks).

METHODS

T2-weighted magnetic resonance brain images of 80 VPT children were acquired at TEA and automatically segmented into cortical gray matter, deep subcortical gray matter, white matter (WM), cerebellum (CB), and cerebrospinal fluid. The gray matter structure of the amygdala was manually segmented. Children were examined at 5 years of age with a behavioral assessment, using the strengths and difficulties questionnaire (SDQ). The utility of brain volumes at TEA, perinatal factors, and social economic risk for the prediction of behavioral outcome was investigated using support vector machine classifiers and permutation feature importance.

RESULTS

The predictive modeling of the volumetric data showed that WM, amygdala, and CB volumes were the best predictors of the SDQ emotional symptoms score. Among the perinatal factors, sex, sepsis, and bronchopulmonary dysplasia were the best predictors of the hyperactivity/inattention score. When combining the social economic risk with volumetric and perinatal factors, we were able to accurately predict the emotional symptoms score. Finally, social economic risk was positively correlated with the scores of conduct problems and peer problems.

CONCLUSIONS

This study provides information on the relation between brain structure at TEA and clinical perinatal factors with behavioral outcome at age 5 years in VPT children. Nevertheless, the overall predictive power of our models is relatively modest, and further research is needed to identify factors associated with subsequent behavioral problems in this population.

Risk-Taking Behavior of Adolescents and Young Adults Born Preterm

OBJECTIVES

To study sexually transmitted Chlamydia trachomatis infections (STCTs), teenage pregnancies, and payment defaults in individuals born preterm as proxies for engaging in risk-taking behavior.

STUDY DESIGN

Our population-based register-linkage study included all 191 705 children alive at 10 years (8492 preterm [4.4%]) born without malformations in Finland between January 1987 and September 1990 as each mother's first child within the cohort. They were followed until young adulthood. We used Cox regression to assess the hazards of STCTs, teenage pregnancies, payment defaults, criminal offending, and substance abuse by gestational age. Gestational age was considered both as a continuous and categorical (extremely, very, moderately, late preterm, early term, post term, and full term as reference) exposure.

RESULTS

A linear dose-response relationship existed between gestational age and STCT and teenage pregnancy; adjusted hazard for STCT decreased by 1.6% (95% CI, 0.7%-2.6%), and for teenage pregnancy by 3.3% (95% CI, 1.9%-4.8%) per each week decrease in gestational age. Those born extremely preterm (23-27 completed weeks) had a 51% (95% CI, 31%-83%) lower risk for criminal offending than their full-term born counterparts, and those born very preterm (range, 28-31 weeks) had a 28% (95% CI, 7%-53%) higher hazard for payment defaults than those born at full term. Gestational age was not associated with substance abuse.

CONCLUSIONS

The lower risk-taking that characterizes people born preterm seems to generalize to sexual and to some extent criminal behavior. Those born very preterm are, however, more likely to experience payment defaults.

Handedness in low-birthweight children: Insights in lateralization

Low-birthweight (LBW) children (n = 96) weighing less than 2.5 kg at birth and normal birthweight (NBW) children (n = 96) from Delhi, India, between the ages of 5 and 12 years were assessed for intelligence with Ravens Colored Progressive Matrices (RCPM), their handedness and hand proficiency for unimanual and bimanual performance. The objective was to know if there is a relation between birthweight and the development of handedness. Compared with NBW children, the LBW group had lower percentile scores for the RCPM. The LBW children were less lateralized than the NBW children in the hand preference test. The LBW children were faster than the NBW for sorting objects with each hand separately, but they were slower in the bimanual envelope task. This indicates a delay in interhemispheric transfer and the development of the corpus callosum that connects the cerebral hemispheres to enable bimanual coordination. In the absence of more direct evidence, hand skill was used as an index of the extent of lateralized control for performance. Findings indicate a relation between birthweight and lateralization in children tested for hand preference.

Reduced health-related quality of life in children born extremely preterm in 2006 compared with 1995: the EPICure Studies

OBJECTIVE

To compare health-related quality of life (HRQL) in childhood for extremely preterm (EP) births before 26 weeks of gestation in England in two eras: 1995 and 2006.

DESIGN

Prospective cohort studies.

SETTING

School or home-based assessments at 11 years of age.

PARTICIPANTS

Available data for 88 EP children born before 26 weeks of gestation in 2006 (EPICure2) were compared with those of 140 born in England during 1995 (EPICure). To account for social secular trends, the comparison between eras was also made for term-born controls as reference.

MAIN OUTCOME MEASURES

HRQL was measured using the parent-completed Health Utilities Index (HUI) questionnaire with utility scores calculated using the HUI3 classification system. Eight attributes were assessed: vision, hearing, speech, ambulation, dexterity, emotion, cognition and pain.

RESULTS

At 11 years, mean utility scores were significantly lower in EPICure2 (2006) than in EPICure (1995; Δ -0.12, 95% CI -0.20 to -0.04). The difference increased (Δ -0.27, 95% CI -0.41 to -0.12) after adjusting for significant perinatal and demographic differences between cohorts. Rates of suboptimal function were increased in EPICure2 for all eight attributes, but statistically significant differences were only found in speech (p=0.004) and dexterity (p=0.020). After excluding children with severe neurodevelopmental impairment, the adjusted difference between cohorts remained significant but attenuated (-0.14 (-0.26 to -0.01)). Mean utility scores for controls were similar between cohorts (Δ -0.01 (-0.04 to 0.02)).

CONCLUSIONS

Using parent report, there was a clinically significant decline in HRQL ratings for EP children over time. Areas contributing the most to the decline were speech and dexterity.

TRIAL REGISTRATION NUMBER

ISRCTN86323684.

Amygdala subnuclei volumes, functional connectivity, and social–emotional outcomes in children born very preterm

Children born very preterm can demonstrate social-cognitive impairments, which may result from limbic system dysfunction. Altered development of the subnuclei of the amygdala, stress-sensitive regions involved in emotional processing, may be key predictors of social-skill development. In a prospective cohort study, 7-year-old children born very preterm underwent neurodevelopmental testing and brain MRI. The Child Behavioral Checklist was used to assess social–emotional outcomes. Subnuclei volumes were extracted automatically from structural scans (n = 69) and functional connectivity (n = 66) was examined. General Linear Models were employed to examine the relationships between amygdala subnuclei volumes and functional connectivity values and social–emotional outcomes. Sex was a significant predictor of all social–emotional outcomes (P < 0.05), with boys having poorer social–emotional outcomes. Smaller right basal nuclei volumes (B = -0.043, P = 0.014), smaller right cortical volumes (B = -0.242, P = 0.02) and larger right central nuclei volumes (B = 0.85, P = 0.049) were associated with increased social problems. Decreased connectivity strength between thalamic and amygdala networks and smaller right basal volumes were significant predictors of greater social problems (both, P < 0.05), effects which were stronger in girls (P = 0.025). Dysregulated maturation of the amygdala subnuclei, along with altered connectivity strength in stress-sensitive regions, may reflect stress-induced dysfunction and can be predictive of social–emotional outcomes.

Neurodevelopmental disorders and somatic diagnoses in a national cohort of children born before 24 weeks of gestation

AIM

This study investigated childhood diagnoses in children born extremely preterm before 24 weeks of gestation.

METHODS

Diagnoses of neurodevelopmental disorders and selected somatic diagnoses were retrospectively retrieved from national Swedish registries for children born before 24 weeks from 2007 to 2018. Their individual medical files were also examined.

RESULTS

We studied 383 children born at a median of 23.3 (range 21.9-23.9) weeks, with a median birthweight of 565 (range 340-874) grams. Three-quarters (75%) had neurodevelopmental disorders, including speech disorders (52%), intellectual disabilities (40%), attention deficit hyperactivity disorder (30%), autism spectrum disorders (24%), visual impairment (22%), cerebral palsy (17%), epilepsy (10%) and hearing impairment (5%). More boys than girls born at 23 weeks had intellectual disabilities (45% vs. 27%, p < 0.01) and visual impairment (25% vs. 14%, p < 0.01). Just over half of the cohort (55%) received habilitation care. The majority (88%) had somatic diagnoses, including asthma (63%) and failure to thrive/short stature (39%).

CONCLUSION

Most children born before 24 weeks had neurodevelopmental disorders and/or additional somatic diagnoses in childhood and were referred to habilitation services. Clinicians should be aware of the multiple health and developmental problems affecting these children. Resources are needed to identify their long-term support needs at an early stage.

Emotion Recognition in Preterm and Full-Term School-Age Children

Children born preterm (<37 weeks’ gestation) show a specific vulnerability for socio-emotional difficulties, which may lead to an increased likelihood of developing behavioral and psychiatric problems in adolescence and adulthood. The accurate decoding of emotional signals from faces represents a fundamental prerequisite for early social interactions, allowing children to derive information about others’ feelings and intentions. The present study aims to explore possible differences between preterm and full-term children in the ability to detect emotional expressions, as well as possible relationships between this ability and socio-emotional skills and problem behaviors during everyday activities. We assessed 55 school-age children (n = 34 preterm and n = 21 full-term) with a cognitive battery that ensured comparable cognitive abilities between the two groups. Moreover, children were asked to identify emotional expressions from pictures of peers’ faces (Emotion Recognition Task). Finally, children’s emotional, social and behavioral outcomes were assessed with parent-reported questionnaires. The results revealed that preterm children were less accurate than full-term children in detecting positive emotional expressions and they showed poorer social and behavioral outcomes. Notably, correlational analyses showed a relationship between the ability to recognize emotional expressions and socio-emotional functioning. The present study highlights that early difficulties in decoding emotional signals from faces may be critically linked to emotional and behavioral regulation problems, with important implications for the development of social skills and effective interpersonal interactions.

Motor Performance in Association with Perceived Loneliness and Social Competence in 11-Year-Old Children Born Very Preterm

Background: Very preterm birth may affect motor performance and social competence up to adulthood. Our objective was to describe perceived loneliness and social competence in children born very preterm in relation to motor impairment. Methods: 165 children born very preterm (birth weight ≤ 1500 g and/or gestational age < 32 weeks) were assessed at 11 years of age. Cerebral palsy (CP) was diagnosed by 2 years of age. At 11 years of age, motor outcome was assessed using the Movement Assessment Battery for Children—Second edition (Movement ABC-2). Loneliness was evaluated by using the Peer Network and Dyadic Loneliness scale and social competence by using the Multisource Assessment of Children’s Social Competence Scale. Results: In total, 6 (4%) children had CP, 18 (11%) had Developmental Coordination Disorder (DCD) (Movement ABC-2 ≤ 5th percentiles), and 141 (85%) had typical motor development. There was no correlation between percentiles for total scores of the Movement ABC-2 and perceived loneliness or social competence when the children with motor impairment (CP or DCD) were excluded. Children with DCD reported less perceived loneliness, but more problems with social competence compared to children with CP. Conclusions: It is important to recognize children born very preterm with DCD to provide interventions and support services to prevent social exclusion.

Development of the mentalizing network structures and theory of mind in extremely preterm youth

Adolescents born preterm (<37 weeks of gestation) are at elevated risk for deficits in social cognition and peer relationships. Theory of Mind (ToM) is a complex form of social cognition important for regulating social interactions. ToM and the underlying mentalizing network continue to develop across adolescence. The present study recruited 48 adolescents (12-17 years old) who were either born extremely preterm (EPT; <28 weeks of gestation) or full-term (FT) at birth. Cortical thickness, gray matter volume and surface area were measured in four regions of the mentalizing network: the temporoparietal junction, anterior temporal cortex, posterior superior temporal sulcus and frontal pole (mBA10). We also assessed the adolescents' performance on a ToM task. Findings revealed both group differences and group-by-age interaction effects in the gray matter indices within the temporal lobe regions of the mentalizing network. The EPT group also performed significantly worse than the FT group on the ToM task. The cortical structural measures that discriminated the EPT and FT groups were not related to ToM performance. These results highlight altered developmental changes in brain regions underlying mentalizing functions in EPT adolescents relative to FT controls.

Social-Cognitive Network Connectivity in Preterm Children and Relations With Early Nutrition and Developmental Outcomes

Infants born very low birth weight (VLBW, < 1,500 g) are at a heightened risk for structural brain abnormalities and social-cognitive deficits, which can impair behavioural functioning. Resting-state fMRI, reflecting a baseline level of brain activity and underlying social-cognitive processes, has also been reported to be altered in children born VLBW. Yet very little is known about the functional networks underlying social cognition using magnetoencephalography (MEG) and how it relates to neonatal factors and developmental outcomes. Thus, we investigated functional connectivity at rest in VLBW children and the associations with early nutrition and IQ and behavioural problems. We collected resting-state MEG recordings and measures of IQ and social-cognitive behaviour, as well as macronutrient/energy intakes during initial hospitalisation in 5-year-old children born VLBW (n = 37) compared to full-term (FT; n = 27) controls. We examined resting-state network differences controlling for sex and age at scan. Functional connectivity was estimated using the weighted phase lag index. Associations between functional connectivity with outcome measures and postnatal nutrition were also assessed using regression analyses. We found increased resting-state functional connectivity in VLBW compared to FT children in the gamma frequency band (65–80 Hz). This hyper-connected network was primarily anchored in frontal regions known to underlie social-cognitive functions such as emotional processing. In VLBW children, increased functional connectivity was related to higher IQ scores, while reduced connectivity was related to increased behavioural problems at 5 years of age. These within-group associations were found in the slower frequency bands of theta (4–7 Hz) and alpha (8–12 Hz), frequently linked to higher-order cognitive functions. We also found significant associations between macronutrient (protein and lipid) and energy intakes during the first postnatal month with functional connectivity at preschool-age, highlighting the long-term impacts of postnatal nutrition on preterm brain development. Our findings demonstrate that at preschool-age, VLBW children show altered resting-state connectivity despite IQ and behaviour being in the average range, possibly reflecting functional reorganisation of networks to support social-cognitive and behavioural functioning. Further, our results highlight an important role of early postnatal nutrition in the development of resting-state networks, which in turn may improve neurodevelopmental outcomes in this vulnerable population.

Effects of Family Nurture Intervention in the NICU on Theory of Mind Abilities in Children Born Very Preterm: A Randomized Controlled Trial

Preterm infants are at risk for socioemotional deficits, neurodevelopmental disorders, and potentially theory of mind (ToM) deficits. Preterm infants enrolled in a randomized controlled trial in the neonatal intensive care unit (NICU) received Standard Care (SC) or Family Nurture Intervention (FNI). Children (N = 72; median age 61.8 ± 2.6 months; FNI: 35 (55%), SC:2 9 (45%)) completed a ToM task, of whom 64 (54% male; born to White (43.8%), Black (18.7%), and Hispanic (25.0%) mothers) contributed to this analysis. FNI and SC infants born extremely preterm to very preterm differed significantly: 78% (14 of 18) of FNI children passed vs. 30% (3 of 10) SC children (p = 0.01, effect size = 1.06). This large effect size suggests that FNI in the NICU may ameliorate deficits in social-cognitive skills of extreme to very preterm infants by school age.

Neurobehavioral Phenotype and Dysexecutive Syndrome of Preterm Children: Comorbidity or Trigger? An Update

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.

Use of non-conventional biomarkers in the early diagnosis of acute kidney injury in preterm newborns with sepsis

Acute kidney injury (AKI) is a common finding in Neotatal Intensive Care Units (NICU). Sepsis is one the main causes of AKI in preterm newborns. AKI has been associated with significant death rates. Early detection of the condition is the first step to improving prevention, treatment, and outcomes, while decreasing length of hospitalization, care costs, and morbimortality. AKI may progress to chronic kidney disease (CKD), a condition linked with dialysis and greater risk of cardiovascular disease. This review article aims to discuss cases of AKI in preterm newborns with sepsis, the use of biomarkers in lab workup, and the use of non-conventional biomarkers for the early identification of AKI.

The Impact of an Interactive Guidance Intervention on Sustained Social Withdrawal in Preterm Infants in Chile: Randomized Controlled Trial

BACKGROUND

Sustained social withdrawal is a key indicator of child emotional distress and a risk factor for psychological development. Preterm infants have a higher probability of developing sustained social withdrawal than infants born full-term during their first year.

OBJECTIVE

To compare the effect of a behavioral guidance intervention to that of routine pediatric care on sustained social withdrawal behavior in preterm infants.

DESIGN

Multicenter randomized clinical trial.

PARTICIPANTS

Ninety nine moderate and late preterm newborns and their parents were recruited and randomized into two groups, i.e., Intervention (n = 49) and Control (n = 50). Both groups attended medical check-ups at 2, 6 and 12 months and were assessed with the Alarm Distress Baby Scale. The intervention group received a standardized behavioral intervention if the neonatologist detected sustained social withdrawal. Also, parents filled out the Edinburgh Postnatal Depression Scale, the modified-Perinatal Posttraumatic Stress Disorder Questionnaire, and the Impact of Event Scale-revised.

RESULTS

At baseline, the prevalence of withdrawal was 4.0% (95% CI: 0.03-14.2) for the control group and 22.4% (95% CI: 13.0-35.9) for the intervention group [OR = 0.22, p = 0.028 (95% CI =0.06-0.84)]. At 6 months, the prevalence was 10.0% (95% CI: 3.9-21.8) for the control group and 6.1% (95% CI: 2.1-16.5) for the intervention group [OR = 2.09, p = 0.318 (95% CI = 0.49-8.88)]. At 12 months, the prevalence was 22.0% (95% CI: 12.8-35.2) for the control group and 4.1% (95% CI: 1.1-13.7) for the intervention group [OR = 6.63, p = 0.018 (95% CI = 1.39-31.71)]. Logistic generalized estimating equation models were performed. The pooled crude OR (considering diagnosis at 6 and 12 months) was 3.54 [p = 0.022 (95% CI = 1.20-10.44); Cohen's d= 0.70]. In the case of pooled adjusted OR, the model considered diagnosis (0 = Withdrawal, 1 = Normal) as the dependent variable, time of evaluation (1= 6 months, 2 = 12 months) and group (0 = Control, 1 = Experimental) as factors. In this case, the pooled adjusted OR was 3.57 [p = 0.022 (95% CI = 1.20-10.65); Cohen's d = 0.70].

CONCLUSION

Assessment and intervention of sustained social withdrawal in preterm infants via standardized instruments benefits families by reducing its prevalence, and possible associated negative outcomes.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov; https://clinicaltrials.gov/ct2/show/NCT03212547, identifier: NCT03212547.

Gestational Age, Parent Education, and Education in Adulthood

BACKGROUND

Adults born preterm (<37 weeks) have lower educational attainment than those born term. Whether this relationship is modified by family factors such as socioeconomic background is, however, less well known. We investigated whether the relationship between gestational age and educational attainment in adulthood differed according to parents' educational level in 4 Nordic countries.

METHODS

This register-based cohort study included singletons born alive from 1987 up to 1992 in Denmark, Finland, Norway, and Sweden. In each study population, we investigated effect modification by parents' educational level (low, intermediate, high) on the association between gestational age at birth (25-44 completed weeks) and low educational attainment at 25 years (not having completed upper secondary education) using general estimation equations logistic regressions.

RESULTS

A total of 4.3%, 4.0%, 4.8%, and 5.0% singletons were born preterm in the Danish (n = 331 448), Finnish (n = 220 095), Norwegian (n = 292 840), and Swedish (n = 513 975) populations, respectively. In all countries, both lower gestational age and lower parental educational level contributed additively to low educational attainment. For example, in Denmark, the relative risk of low educational attainment was 1.84 (95% confidence interval 1.44 to 2.26) in adults born at 28 to 31 weeks whose parents had high educational level and 5.25 (95% confidence interval 4.53 to 6.02) in adults born at 28 to 31 weeks whose parents had low educational level, compared with a reference group born at 39 to 41 weeks with high parental educational level.

CONCLUSIONS

Although higher parental education level was associated with higher educational attainment for all gestational ages, parental education did not mitigate the educational disadvantages of shorter gestational age.

Motor outcomes of children born extremely preterm; from early childhood to adolescence

Children and adolescents born extremely preterm (EP; <28 weeks' gestation) are at greater risk of motor impairment, including cerebral palsy and developmental coordination disorder, than their term born peers. Importantly, motor impairment has implications beyond performing motor skills; it negatively affects outcomes as diverse as school success, emotional wellbeing, physical health, and physical activity (PA) participation. This review will outline what is known about PA participation across childhood and adolescence for children born EP and term, recognising that PA may improve physical, social, and mental health outcomes. Critically, PA participation occurs in the context of children's and adolescents' daily lives, and is influenced by the family, social and physical environment, as well as by the child's personal factors, such as motor impairment. Further research is needed to better understand PA participation levels and correlates for children and adolescents born preterm, to better inform effective and sustainable interventions.

Gestational age on trajectories of social competence difficulties into adolescence

OBJECTIVES

To examine if gestational age groups predict the development of social competence difficulties (SCDs) from childhood into mid-adolescence and to assess the mediation by maternal psychological distress during infancy on these trajectories.

DESIGN

Nationally representative population-based birth cohort (UK Millennium Cohort Study).

PARTICIPANTS

15 821 children born in 2000-2002.

OUTCOME MEASURES

SCDs (derived from peer and prosocial subscales of Strengths and Difficulties Questionnaire) were assessed by parent report when the participants were aged 3, 5, 7, 11 and 14 years. Maternal psychological distress was self-rated using Rutter Malaise Inventory when the children were 9 months of age. Data were modelled using latent growth curve analysis.

RESULTS

Developmental trajectories of SCDs were U-shaped in all groups. Very preterm (VP) children (<32 weeks, n=173) showed pronounced difficulties throughout, with the coefficient difference from the full term at age 14 being 0.94 (95% CI 0.23 to 1.66, equivalent to 0.32 SD of the population average SCDs). Moderate-to-late preterm children (32-36 weeks, n=1130) and early-term children (37-38 weeks, n=3232) showed greater difficulties compared with the full-term peers around age 7 years, which resolved by age 14 years (b=0.20, 95% CI -0.05 to 0.44; b=0.03, 95% CI -0.12 to 0.17, respectively). Maternal psychological distress during infancy mediated 20% of the aforementioned association at age 14 years for the VP.

CONCLUSION

There was a dose-response association between gestational age and the trajectories of SCDs. Monitoring and providing support on social development throughout childhood and adolescence and treating early maternal psychological distress may help children who were born earlier than ideal, particularly those born VP.

Social Functioning in Adults Born Very Preterm: Individual Participant Meta-analysis

CONTEXT

There is a lack of research on individual perceptions of social experiences and social relationships among very preterm (VP) adults compared with term-born peers.

OBJECTIVE

To investigate self-perceived social functioning in adults born VP (<32 weeks' gestation) and/or with very low birth weight (VLBW) (<1500g) compared with term-born adults (≥37 weeks' gestation) using an individual participant data (IPD) meta-analysis.

DATA SOURCES

Two international consortia: Research on European Children and Adults born Preterm and Adults Born Preterm International Collaboration.

STUDY SELECTION

Cohorts with outcomes assessed by using the Adult Self-Report Adaptive Functioning scales (friends, spouse/partner, family, job, and education) in both groups.

DATA EXTRACTION

IPD from 5 eligible cohorts were collected. Raw-sum scores for each scale were standardized as z scores by using mean and SD of controls for each cohort. Pooled effect size was measured by difference (Δ) in means between groups.

RESULTS

One-stage analyses (1285 participants) revealed significantly lower scores for relationships with friends in VP/VLBW adults compared with controls (Δ -0.37, 95% confidence interval [CI]: -0.61 to -0.13). Differences were similar after adjusting for sex, age, and socioeconomic status (Δ -0.39, 95% CI: -0.63 to -0.15) and after excluding participants with neurosensory impairment (Δ -0.34, 95% CI: -0.61 to -0.07). No significant differences were found in other domains.

LIMITATIONS

Generalizability of research findings to VP survivors born in recent decades.

CONCLUSIONS

VP/VLBW adults scored their relationship with friends lower but perceived their family and partner relationships, as well as work and educational experiences, as comparable to those of controls.

The Neurobehavioral Phenotype of School-Aged, Very Prematurely Born Children with No Serious Neurological Sequelae: A Quality of Life Predictor

School-aged extremely preterm (EPT) children have multiple specific neurocognitive/behavioral disorders that are often associated with other disorders; this manifests a true neurobehavioral “phenotype” of prematurity. To determine a profile of cognitive/behavioral impairments in a population of school-aged EPT children (7–10 years-old) without major disabilities, a cross-sectional study was conducted in five medical centers. An algorithm distributed the study population according to four WISC-IV subtests, five NEPSY-2 subtests, and two variables of figure of Rey. The behavior (SDQ), anxiety (Spielberg STAI-C), and generic QoL (Kidscreen 10 and VSP-A) were also evaluated. The study included 231 school-aged EPT children. Three neurobehavioral “phenotypes” were defined according to their severity: 1 = moderately, 2 = minor, and 3 = unimpaired. In all the profiles, the working memory, perceptual reasoning, as well as mental flexibility, were close to or below average, and their emotional behavior was always troubled. Self-esteem and school-work were the most impacted QoL areas. The unimpaired neurobehavior exhibited emotional behavioral impairment and executive dysfunction. The profile analysis defined distinct outcome groups and provided an informative means of identifying factors related to developmental outcomes. The QoL deterioration is determined by the severity of the three neurobehavioral “phenotypes”, which is defined as well as by dysexecutive and/or behavioral disorders.

The Impact of Formal School Entry on Children's Social Relationships with Parents, Siblings, and Friends

The normative transition to formal schooling confronts children with social challenges but also opportunities. Longitudinal research on how school entry impacts children's family and friend-ship relationships is scarce. This study investigated social relationship qualities with parents, siblings, and friends among 1110 children (49.9% female) from the prospective, population-based Bavarian Longitudinal Study at 6 years (before school entry) and 8 years using a forced-choice card-sorting task. Multivariate analyses of variance revealed significant effects of age (i.e., school entry) on social relationship qualities with mothers (Pillai's Trace (PT) = 0.28, F(9, 1101) = 47.73, p < 0.001), fathers (PT = 0.14, F(9, 1101) = 19.47, p < 0.001), siblings (PT = 0.27, F(9, 1101) = 46.14, p < 0.001), and friends (PT = 0.21, F(9, 1101) = 32.57, p < 0.001). On average, children reported higher levels of parental comfort after school entry. Companionable qualities increased in relationships with friends, whereas sibling relationships became more conflictual from preschool to early school age. Findings provide unique insights into how social relationships develop from preschool to early school age, supporting evidence of the growing importance of friends. Conflict was predominant and increasing in sibling relationships and should be considered more in future research.

Newborn Neurobehavior Is Related to Later Neurodevelopment and Social Cognition Skills in Extremely Preterm-Born Children: A Prospective Longitudinal Cohort Study

Objective: The aim of this study was to evaluate the ability of the neonatal neurobehavioral characteristics to act as an indicator for later neurodevelopment and neurocognitive performance.

Methods: Sixty-six infants born extremely preterm (<28 gestational weeks) were followed until 6.5 years. Neurobehavior at term age was assessed by the behavior subscale of the Hammersmith Neonatal Neurological Examination (HNNE) using dichotomic rating, optimal, and non-optimal. The Griffiths Mental Developmental Scales (GMDS) at 2 years, and the Wechsler Intelligence Scales at 6.5 years, and a Neuropsychological Assessment at 6.5 years were used to assess neurodevelopment and neurocognitive performance including social cognition skills.

Results: An optimal auditory orientation at term age was associated with better developmental quotients (DQ) in Personal–Social, and Hearing–Language GMDS subscale at 2 years (p < 0.05). An optimal visual alertness was associated with better Total (p < 0.01), Locomotor (p < 0.001), and Eye–Hand Coordination (p < 0.01) DQs at 2 years, and with sensorimotor function (p < 0.001) and social perception (p < 0.01) tests at 6.5 years.

Conclusion: The neurobehavioral characteristics of newborns might serve as a precursor of social cognition skills and the HNNE behavior subscale offers a tool to identify infants at risk for later deficits in neurodevelopment and social cognition.

Neurological, cognitive and learning evaluation of students who were born preterm

Objective:

To evaluate the cognitive and academic profile of preterm newborns at school age and to determine the factors related to prematurity and sociodemographic profile that influence these results.

Methods:

Patients aged 6-14 years old that were assisted in the preterm follow-up clinic were recruited. The cognitive, academic, and neurological capacities were accessed through a detailed evaluation with a child neurologist, a neuropsychologist and a psychopedagogue. Neonatal data were collected from patient records.

Results:

97 children were included and 14 were excluded from the study, resulting in 83 children. Gestational age (GA) was 30±3 weeks and weight at birth was 1138g (605 to 4185g). Poor performance was shown in 38.4% for writing, 57.5% for reading and 42.5% for mathematics. The mean total intelligence quotient (IQ) was 96±14.9 points, and 10.9% were considered altered. Children with unstructured families presented 78.3% of failure in reading tests (p=0.029). The multivariate analysis showed association between GA at birth and classic mini-mental score (p=0.043), total IQ (p=0.047), perceptual organization IQ (p=0.035), and processing speed IQ (p=0.036). There was also association between weight at birth and the classic (p=0.004) and adapted (p=0.007) mini-mental scores; invasive mechanic ventilation duration and classic mini-mental (p=0.049); and lower maternal age and processing speed IQ (p=0.033).

Conclusions:

Preterm infants at school age had high frequency of failure in cognitive and academic evaluation tests. Learning difficulties are high among them. Multiple neonatal variables are related with altered cognitive and students development.

Maternal depressive symptoms, poverty, and young motherhood increase the odds of early depressive and anxiety disorders for children born prematurely

Children born preterm, compared to term, are at risk for behavioral problems. However, the prevalence and predictors of internalizing disorders among children born preterm are unclear. The purpose of this study was to identify the prevalence of depressive and anxiety disorders at 2 years of age among children born preterm and determine the extent to which poverty, maternal depressive symptoms, or young motherhood increase the likelihood of these disorders. Mothers and their infants (N = 105) were recruited from two neonatal intensive care units affiliated with a major U.S. university. A sociodemographic questionnaire, the Patient Health Questionnaire‐9, and the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition scale scores from the Preschool Child Behavior Checklist were used to measure primary variables. We examined mothers’ family satisfaction and quality of caregiving as well as children's degree of prematurity, morbidity, gender, cognitive functioning, and motor function as covariates. Fifteen percent of children met criteria for an anxiety disorder and another 15% for depression. Maternal depressive symptoms increased the odds of children developing both anxiety and depression, whereas young motherhood was associated with child anxiety and poverty with child depression. Results indicate the need for mental health assessment of children born preterm during their first 2 years of life and the importance of early therapeutic and tangible support to vulnerable mothers and children.

Social functioning questionnaires of adolescents born preterm show average profiles and attenuated sex differences

AIM

Prematurity has been shown to affect social competence in children and adults. Our aim was to evaluate profiles of self-reported social behaviours and loneliness in preterm- and term-born adolescents.

METHODS

Preterm (≤1500 g and, or, <32 gestational weeks)- and term-born infants were recruited in Turku University Hospital from 2001 to 2006. The Multisource Assessment of Children's Social Competence Scale and the Peer Network and Dyadic Loneliness Scale were completed at the age of 11. Profiles of social competence and loneliness were labelled as low, average or high.

RESULTS

A total of 172 preterm-born and 134 term-born adolescents returned the questionnaires. Most frequently, preterm adolescents reported a profile of average social competence and average levels of loneliness. Preterm-born boys reported a profile of low social functioning less often (preterm-born 36% vs. term-born 54%), and preterm-born girls reported a profile of high social functioning less frequently (preterm-born 26% vs. term-born 37%) than same-sex controls. Sex differences in social functioning profiles were smaller in preterm than term-born adolescents.

CONCLUSION

The majority of young adolescents born preterm reported a high or average social functioning profile irrespective of sex. Prematurity seems to level out differences between the sexes.

Social cognition following preterm birth: A systematic review

Social cognitive abilities are affected by preterm birth, but pathways to, and risk factors for this outcome are not well mapped. We examined direct assessment tasks including objective coding of parent-child play to chart social development in infancy and pre-school years. A systematic search and data-extraction procedure yielded seventy-nine studies (4930 preterm and 2109 term children, aged birth - five years), for inclusion. We detected a pattern of reduced social attention in the first 12 months of life with evidence of reduced performance in social cognitive tasks later in the preschool years. However, we did not identify a consistent, distinctive preterm social phenotype in early life. Instead, the interactive behaviour of preterm infants reflects factors from outside the social cognitive domain, such as attention, language, and socioeconomic status. By combining data across samples and measures we revealed the role of domain-general skills, which may in future prove fruitful intervention targets.

Energy-enhanced parenteral nutrition and neurodevelopment of preterm newborns: A cohort study

OBJECTIVES

Preterm births are at higher risk for neurodevelopment (NDV) disabilities. To limit long-term consequences, guidelines recommend aggressive parenteral nutrition (PN) soon after birth. The aim of this study was to examine the effects of energy-enhanced PN in the first week of life on long-term NDV in preterm neonates.

METHODS

We compared two cohorts of newborns (group A: energy-enhanced PN and group B: energy-standard PN) with different energy intake in the first 7 d of life (DoL) given by PN with the same protein amount, to study the influences of an energy-enhanced PN on NDV at 24 mo of life evaluated with the Bayley Scale of Infant Development-III edition.

RESULTS

We analyzed 51 newborns (A: n = 24 versus B: n = 27). The two cohorts were similar in baseline characteristics (gestational age group A 29 wk, 95% confidence interval [CI], 28-30 wk versus group B 29 wk, 95% CI, 28-30 wk; birth weight A: 1214 g, 95% CI, 1062-1365 g versus B 1215 g, 95% CI, 1068-1363 g; boys A 62.5% versus B 55.6%). Infants in cohort B showed significantly (P < 0.05) better gross motor, total scaled, and total composite motor scores (A: 8 (1) versus B 9 (2); A 17 (4) versus B 19 (5); A 91 (12) versus B 97 (15); respectively). Cohort A showed a higher percentage of infants with delayed socioemotional competence (A 30.4% versus B 7.7%, P < 0.05). No differences were found in growth parameters at 24 mo of life. Linear regression analysis showed that socioemotional competence and motor score were negatively associated with energy intake of the first 7 DoL given by PN.

CONCLUSIONS

A more aggressive PN strategy results in lower motor score and socioemotional competence performance at 24 mo of life. More caution might be advocated for an energy-enhanced PN protocol, particularly in neonates with lower birth weight, for long-term NDV in preterm neonates.

The preterm social brain: altered functional networks for Theory of Mind in very preterm children

Neurodevelopmental difficulties emerge in very preterm born children (<32-week gestation) in infancy and continue to early adulthood but little is known about their social-cognitive development. This study utilized the complementary methodological advantages of both functional MRI and magnetoencephalography to examine the neural underpinnings of Theory of Mind in very preterm birth. Theory of Mind, one of the core social-cognitive skills, is the ability to attribute mental states to others, and is crucial for predicting others’ behaviours in social interactions. Eighty-three children (40 very preterm born, 24 boys, age = 8.7 ± 0.5 years, and 43 full-term born, 22 boys, age = 8.6 ± 0.5 years) completed the study. In functional MRI, both groups recruited classic Theory of Mind areas, without significant group differences. However, reduced Theory of Mind connectivity in the very preterm born group was found in magnetoencephalography in distinct theta, alpha and beta-band networks anchored in a set of brain regions that comprise the social brain. These networks included regions such as the angular gyrus, the medial pre-frontal cortex, the superior temporal gyrus and the temporal poles. Very preterm born children showed increased connectivity compared to controls in a network anchored in the occipital gyri rather than classical social-processing regions. Very preterm born children made significantly more attribution errors and mis-construed the social scenarios. Findings offer novel insight into the neural networks, supporting social cognition in very preterm born children and highlight the importance of multimodal neuroimaging to interrogate the social brain in clinical populations.

Anxiety and Depressive Disorders in Children Born Preterm: A Meta-Analysis

OBJECTIVE

Preterm birth is associated with a high prevalence of psychiatric disorders including internalizing problems. However, there is a lack of consensus on the risk for depression and on specific diagnostic profiles. This meta-analysis investigates the independent pooled odds of Diagnostic and Statistical Manual of Mental Disorders Fourth Edition anxiety and depressive disorders in children between 3 and 19 years of age born preterm compared with their term-born peers.

METHOD

PubMed/MEDLINE, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature electronic databases were searched (last updated in September 2019) using population ("child"), exposure ("preterm birth"), and outcome ("anxiety") terms for English peer-reviewed publications. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed with the risk of bias assessed using the Newcastle-Ottawa Quality Assessment Scale. Pooled odds ratio (OR) with 95% confidence intervals (CIs) was estimated using fixed-effects models.

RESULTS

Eleven independent studies met the inclusion criteria. The pooled sample comprised 1294 preterm and 1274 term-born children with anxiety outcomes and 777 preterm and 784 term-born children with depressive outcomes between 3 and 19 years of age. Children born preterm had significantly greater odds for anxiety (OR: 2.17; 95% CI, 1.43-3.29), generalized anxiety (OR: 2.20; 95% CI, 1.26-3.84), and specific phobia (OR: 1.93; 95% CI, 1.05-3.52) relative to their term-born peers. There were no significant between-group differences for reported depressive disorders.

CONCLUSION

Preterm birth is associated with a higher prevalence of anxiety, but not depressive disorders, from 3 to 19 years of age, suggesting distinct etiological pathways in this high-risk population. The findings support variation in the rates of specific anxiety diagnoses, indicating the need to extend neurodevelopmental surveillance to encompass a holistic emotional screening approach.

Mothers' experiences of parenting and everyday life of children born at 23 weeks of gestation - a qualitative descriptive study

BACKGROUND

Surviving children born at 23 gestational weeks are a growing population. As many of these children face developmental challenges during childhood and adolescence, more knowledge is needed about the everyday life of this group. The parental perspective is important, as developmental problems often pose a challenge for the parents. The aim of this qualitative study was to explore mothers' experiences of parenting children born at 23 gestational weeks and of the children's everyday lives.

METHODS

This was a qualitative descriptive study conducted with mothers of children born at 23 weeks of gestation. These purposively sampled eight mothers were interviewed using a semi-structured interview. Thematic analysis was used to analyse the interviews.

RESULTS

Seven themes were formed on the basis of the interview data and they are presented in three dimensions: 1) the child seen from maternal perspective included themes 'emphasizing strengths in the midst of challenges', 'relations with peers and siblings', and 'emotional well-being and active life'; 2) the parenting experience included themes 'intensive mothering' and 'gratitude'; 3) the support included themes 'support from the social network' and 'support from society'.

CONCLUSIONS

The mothers described how the lives of their children were active and rich. The mothers were dedicated to motherhood and they also expressed feelings of gratitude. Mothers received support from social networks and from society. This qualitative study provided an important complementary perspective to the discussion on extremely premature children's quality of life. It also highlighted the importance of parental perspectives in assessing neonatal care and its outcomes.

Specific cognitive correlates of the quality of life of extremely preterm school-aged children without major neurodevelopmental disability

BACKGROUND

We examined how specific cognitive behavioral impairments impacted quality of life (QoL) within a large multicenter cohort of 7-10 year olds surviving extremely preterm (EPT) without major neurodevelopmental disability.

METHODS

Between 7 and 10 years of age, two generic, self-proxy, and parental evaluations were obtained. QoL measurement questionnaires (Kidscreen-10/VSPA (Vécu et Santé Perçue de l'Enfant et de l'Adolescent)) were used and compared to a reference population. The general and specific cognitive functions, such as executive functions, behavior and anxiety, and clinical neurologic examination, were also assessed.

RESULTS

We analyzed 211 school-aged EPT children. The mean gestational age was 26.2 (±0.8) weeks, birth weight was 879 g (±181) and the mean age was 8.4 years (±0.87). Children with a Full-Scale Index Quotient ≥89, who were considered as normal, had a lower QoL. Specific cognitive impairments: comprehensive language delay, visuo-spatial integration defect, and dysexecutive disorders) were the QoL correlates in the domains of school performance and body image.

CONCLUSIONS

School and health care professionals need to increase their focus on EPT children's lower so as to recognize the preterm behavioral/cognitive phenotype and their potential need for supportive measures. Research on preventive interventions is warranted to investigate if these long-term effects of an EPT birth can be attenuated in neonatal period and after.

Birth weight is associated with adolescent brain development: A multimodal imaging study in monozygotic twins

Previous research has shown that the prenatal environment, commonly indexed by birth weight (BW), is a predictor of morphological brain development. We previously showed in monozygotic (MZ) twins associations between BW and brain morphology that were independent of genetics. In the present study, we employed a longitudinal MZ twin design to investigate whether variations in prenatal environment (as indexed by discordance in BW) are associated with resting‐state functional connectivity (rs‐FC) and with structural connectivity. We focused on the limbic and default mode networks (DMNs), which are key regions for emotion regulation and internally generated thoughts, respectively. One hundred and six healthy adolescent MZ twins (53 pairs; 42% male pairs) followed longitudinally from birth underwent a magnetic resonance imaging session at age 15. Graph theoretical analysis was applied to rs‐FC measures. TrackVis was used to determine track count as an indicator of structural connectivity strength. Lower BW twins had less efficient limbic network connectivity as compared to their higher BW co‐twin, driven by differences in the efficiency of the right hippocampus and right amygdala. Lower BW male twins had fewer tracks connecting the right hippocampus and right amygdala as compared to their higher BW male co‐twin. There were no associations between BW and the DMN. These findings highlight the possible role of unique prenatal environmental influences in the later development of efficient spontaneous limbic network connections within healthy individuals, irrespective of DNA sequence or shared environment.

Umbrella Review of School Age Health Outcomes of Preterm Birth Survivors

Preterm birth affects approximately 10% of U.S. births, with survival rates close to 95%. All health care providers, regardless of population or setting, are treating preterm birth survivors. The purpose of this manuscript is to present an umbrella review of the health outcomes of 2- to 12-year-old children who were born preterm. The current umbrella review consisted of 29 reviews, 14 meta-analyses, eight systematic reviews, and seven described as both meta-analysis and systematic review. Studies were grouped into six health outcome categories: neurodevelopmental, motor and/or cerebral palsy, pulmonary, mental and/or behavioral health, quality of life and/or leisure, and eczema. The analysis supports a resounding recommendation to recognize preterm birth, at all gestations, as a risk factor to health and educational outcomes. Increased attention to developmental screenings is critical, specifically recognition that children who are on the lower ranges of normal may benefit from therapies or interventions that support the attainment of future skills.

Emerging atypical connectivity networks for processing angry and fearful faces in very preterm born children

Very preterm born (VPT) children are those born before 32/40 weeks' gestational age and comprise 10% of the 15 million babies born prematurely worldwide each year. Due to advancements in neonatal medicine, the survival rate of VPT birth has increased, but few studies have investigated the nonmedical, social-cognitive morbidities that affect these children. In this study, we examined emotional face processing networks in VPT compared to age and sex matched full-term born (FT) children. Magnetoencephalography (MEG) was used to test VPT and FT born children at 6 years (n = 78) and 8 years (n = 83). Children were assessed using an implicit emotion face-processing task. Happy, fearful, and angry faces were presented for 150 ms, but children were asked to respond by button press to the location of a control pixelated image of the face displayed on the side of the screen opposite to the face. Children rated the valence of the images on a five-point scale. Group differences showed that VPT children rated angry faces more positively than their FT peers. VPT children had reduced connectivity for angry and fearful faces at 8 years in networks including regions such as the bilateral amygdala, superior temporal sulci, and anterior cingulate gyrus. Interventions should target both emotion recognition, as well as higher cognitive processes related to emotional control and thinking about one's own emotions.

Preterm birth and maternal sensitivity: Findings from a non-western country

INTRODUCTION

Although there are several studies on maternal sensitivity of preterm-born children conducted in Western countries, the factors affecting the sensitivity of mothers of preterm infants have not been investigated outside the Western context.

OBJECTIVES

This study aimed to compare maternal sensitivity of preterm children at 18 months of corrected age with their healthy term-born peers and explore the factors associated with maternal sensitivity in a middle-income non-Western country. Moreover, the associations of maternal sensitivity with socio-demographic factors, maternal depression, and social-emotional competency and behavior problems of infants were investigated.

METHODS

In total, 70 (40 preterm-born and 30 term-born) mother-child dyads participated in this study. An observation-based measurement tool, Maternal Sensitivity Scale, was used to assess maternal sensitivity. Social-emotional competency and behavior problems of infants were evaluated via The Turkish version of the Brief Infant-Toddler Social Emotional Assessment. Maternal depressive symptoms were assessed via the Beck Depression Inventory. In addition, a demographic information form was filled out by the mothers.

RESULTS

Maternal sensitivity scores of preterm infants were significantly lower compared to term infants. Depressive symptoms scores and employment status of mothers, socio-economic status (SES), gestational age, breastfeeding duration, and behavior problems of children were the factors related to maternal sensitivity scores. In hierarchical regression analysis, SES and gestational age were the strongest predictors of maternal sensitivity. After controlling SES and gestational age, maternal depressive symptoms scores negatively predicted maternal sensitivity scores.

CONCLUSION

This study pointed out the factors associated with the maternal sensitivity of preterm infants outside the Western context. Interventions to improve sensitive parenting behaviors of preterm infants are needed, especially in socio-economically disadvantaged groups.