Emotional and Behavioral Problems of Preterm and Full-Term Children at School Entry

Testing the reported long-term advantages of protein-fortified human milk in very low birth weight neonates

Preterm infants are at-risk for extrauterine growth restriction and downward percentile-crossing between birth and discharge. Increased energy and protein intake through fortification of human milk during the first weeks of life has been associated with improved short-term growth and better developmental outcomes. The aim of this study was to evaluate whether these benefits persist up to children school age. The study was designed as an observational study. During hospitalization, 22 very low birth weight preterm infants were fed with increasing protein fortification of human milk (protein supplemented group, PSG). As a control group (CG), 11 preterm infants were fed with standard nutrition regimen. At children school age (9-11 years), we assessed anthropometric data (weight, height, BMI), global health (renal function), and specific psychological outcomes (Child Behavior Checklist 6-18). A global homogeneity between CG and PSG groups emerged: we found no significant differences in weight, height, and BMI, nor in internalizing symptom outcomes (all ps > 0.05). However, mothers reported significantly higher externalizing symptoms for the PSG infants compared to CG infants. Therefore, neonatal enteral protein supplementation in very low birth weight preterm infants leads to no positive nor adverse consequences in long-term assessment, suggesting that benefits are restricted to the neonatal term and first years of age.

Risk of Developmental Disorders in Children Born at 32 to 38 Weeks' Gestation: A Meta-Analysis

CONTEXT

Very preterm birth (<32 weeks) is associated with increased risk of developmental disorders. Emerging evidence suggests children born 32 to 38 weeks might also be at risk.

OBJECTIVES

To determine the relative risk and prevalence of being diagnosed with, or screening positive for, developmental disorders in children born moderately preterm, late preterm, and early term compared with term (≥37 weeks) or full term (39-40/41 weeks).

DATA SOURCES

Medline, Embase, Psychinfo, Cumulative Index of Nursing, and Allied Health Literature.

STUDY SELECTION

Reported ≥1 developmental disorder, provided estimates for children born 32 to 38 weeks.

DATA EXTRACTION

A single reviewer extracted data; a 20% sample was second checked. Data were pooled using random-effects meta-analyses.

RESULTS

Seventy six studies were included. Compared with term born children, there was increased risk of most developmental disorders, particularly in the moderately preterm group, but also in late preterm and early term groups: the relative risk of cerebral palsy was, for 32 to 33 weeks: 14.1 (95% confidence intervals [CI]: 12.3-16.0), 34 to 36 weeks: 3.52 (95% CI: 3.16-3.92) and 37 to 38 weeks: 1.44 (95% CI: 1.32-1.58).

LIMITATIONS

Studies assessed children at different ages using varied criteria. The majority were from economically developed countries. All were published in English. Data were variably sparse; subgroup comparisons were sometimes based on single studies.

CONCLUSIONS

Children born moderately preterm are at increased risk of being diagnosed with or screening positive for developmental disorders compared with term born children. This association is also demonstrated in late preterm and early term groups but effect sizes are smaller.

Assessing Behavioral Disorders with SDQ in Very Preterm Children at 5 Years of Age in LIFT Cohort

BACKGROUND

Preterm-born children are at risk of behavioral disorders and the systematic assessment of these disorders remains a challenge. Questions remain about the accuracy of self-reported parent questionnaires and the real everyday life behavior of the child.

AIM

To evaluate the association between SDQ reported by parents in the preterm and behavioral difficulties in the everyday school life environment reported by teacher.

METHODS

All children born before 33 weeks and who followed-up in the LIFT (Loire Infant Follow-up team) network were included. The Strengths and Difficulties Parental Questionnaire (SDQ), completed at 5 years, was used to check for behavioral difficulties and identified three groups: "normal", "borderline" and "abnormal". Then, the SDQ results were compared to the Global School Adaptation Score (GSA) at 5 years.

RESULTS

Out of the 1825 children followed in the cohort at the age of 5, 1397 questionnaires were analyzed. A total of 11.1% of children had an abnormal score, and 9.7% had a borderline score. Male gender and a lower birth weight z-score were significantly associated with the "abnormal SDQ" group. There is a significant relationship between the probability of being in the "abnormal SDQ" group at 5 years and with difficulty in global school adaptation at 5 years, as well as an SDQ borderline score in the preterm (p < 0.001).

CONCLUSIONS

SDQ abnormal and borderline scores are associated with behavioral difficulties in the classroom and everyday life behavior. In preterm children, one should be alerted even by a borderline SDQ score.

Neonatal stress and behavior problems in preschool children born preterm

The aim of the present longitudinal study was to examine the effect of preterm childbirth, acute neonatal stress, and child behavior at 18-36 months of age on later behavior outcomes in 4-5-year-old children. The sample comprised of 70 children who were born preterm. The neonatal characteristics of children were assessed during hospitalization by reviewing their medical records and utilizing the Neonatal Infant Stressor Scale. Behavior problems were evaluated by the maternal-report in the Child Behavior Checklist 1½-5 years. A multiple linear regression analysis was conducted. Also, the repeated measures analysis of variance and the McNemar test for paired samples were performed. Daily exposure of the infants to high neonatal acute stress during NICU hospitalization and more behavior problems at 18-36 months of age was associated with more total and externalizing behavior problems at 4-5 years of age. Lower gestational age at childbirth and more internalizing behavior problems at 18-36 months was associated with more internalizing problems at 4-5 years old. The present study showed the combination of predictors of neonatal conditions and behavioral problems at childhood, highlighting the relevance of the implementation of developmental care in the NICU and follow-up the preterm infants after discharge programs.

Emotional and behavioural outcomes at 8 years of age in preterm-born children: A longitudinal study

AIM

To evaluate the predictive value of perinatal factors and neurodevelopmental evaluation in the emotional and behavioural outcomes in preterm-born children at 7-9 years of age.

METHODS

We evaluated the Strengths and Difficulties Questionnaire (SDQ) extended score at 8.2 ± 0.2 years, among 70 preterm-born children (32 early and 38 moderately preterms) with a previous Bayley-III neurodevelopmental evaluation.

RESULTS

Early compared to moderately preterms had a higher total SDQ (12 compared to 8, p = 0.031), and emotional symptoms score (4 compared to 3, p = 0.022); no significant differences were recorded in abnormal/borderline-scored children between the two groups. The total SDQ and emotional symptoms scores were significantly correlated with gestational age, birth weight, perinatal factors and the cognitive and motor Bayley-III scores. Early prematurity was associated with the total SDQ score (beta 2.09, 95% CI 1.32, 3.87), and the score of emotional symptoms (beta 1.70, 95% CI 1.38, 2.19), after adjusting for sex, neonatal sepsis and the existence of an older sibling.

CONCLUSION

Prematurity, birth weight, perinatal factors and the cognitive and motor Bayley-III scores were significantly associated with the total SDQ and the emotional symptoms score, in preterm-born children.

Impact of pregnancy-related anxiety on preschoolers' emotional and behavioral development: Gender specificity, critical time windows and cumulative effect

BACKGROUND

Studies on the gender-specific effect of PrA on children's emotional and behavioral development are limited. Lack of PrA data on the entire pregnancy had caused difficulties in identifying the key time window and cumulative effects.

METHODS

Based on Ma'anshan Birth Cohort in China, mothers at pregnancy and children followed up to 4 years of age were tested using the PrA questionnaire and the Achenbach Child Behavior Checklist (CBCL) 1.5-5. Finally, 1699 mother-child pairs were included in the study and regression models were developed for analysis.

RESULTS

Children of mothers with PrA are at significantly elevated risk for abnormal mood/behavior at preschool age. Girls seemed to be more sensitive to maternal PrA than boys, mainly manifested in internalizing problems; The third trimester of pregnancy might be a critical time window when maternal PrA affected children's internalizing problems; Longer the duration women had PrA during pregnancy, more possibilities their children would have to develop internalizing and externalizing problems.

LIMITATIONS

The PrA questionnaire may be different from PrA questionnaires in other countries such as due to different cultural contexts. Findings need to be interpreted with more caution. Factors such as maternal postpartum depression and care practices of nursing staff were not considered. No data were collected on disease as well as caregiver emotional status, which also impacts the reporting and identification of emotional/behavioral problems in children.

CONCLUSIONS

Gender-specific and cumulative effect of PrA on preschoolers' emotional/behavioral development is observed. The third trimester of pregnancy might be the critical time window.

Sex-specific association between placental inflammatory cytokine mRNA expression and preschoolers' behavioral development: The Ma'anshan birth cohort study

BACKGROUND

Placental inflammation may contribute to brain abnormalities and childhood neuropsychiatric disorders, but limited knowledge is available on the association of placental inflammatory cytokine levels and offspring's behavioral development. This study aimed to examine the sex-specific association between placental inflammatory cytokine mRNA expression and preschoolers' behavioral development.

METHODS

3474 pregnant women were recruited as the initial study population in the Ma'anshan birth cohort (MABC) study. Placentas (n = 2519) were collected during childbirth, and the mRNA expression of IL-8, IL-1β, CRP, TNF-α, IL-6, IL-10, and IL-4 was assessed. The Child Behavior Checklist 1.5-5 (CBCL 1.5-5) was used to assess children's behavioral development at 4 years old. A T-score ≥ 60 on summary scales or a score ≥ 65 on syndrome scales was regarded as the borderline clinical range. Multiple linear regression models and binary logistic regression models were applied to explore the sex-specific associations between placental inflammatory cytokines mRNA transcript levels and preschoolers' behavioral development.

RESULTS

Sex-specific associations between placental inflammatory cytokines mRNA expression and preschoolers' behavioral development were observed. There was a positive association between IL-8 and CBCL scores for boys on anxious/depressed problems, aggressive behaviors, externalizing problems and total problems. Logistic regression models showed that high levels of IL-8 were associated with a higher risk of girls' emotionally reactive problems and sleep problems compared to low/medium levels. High TNF-α was correlated with increased sleep problem scores in boys, and medium TNF-α (vs. low levels) was associated with an increased risk of girls' externalizing problems. Medium levels of CRP, IL-1β, and IL-6 were found to be associated with a decreased risk of girls' behavioral problems compared to low/high levels. For anti-inflammatory cytokines, medium IL-10 and IL-4 (vs. low levels) were observed to be associated with a lower risk of internalizing problems in boys and externalizing problems in girls, respectively. High IL-10 was correlated with decreased attention problem scores in boys.

CONCLUSION

This study indicates that placental inflammatory cytokine mRNA expression of IL-8, CRP, TNF-α, IL-1β, IL-4 and IL-10 may be associated with preschoolers' behavioral development in a sex-specific manner.

Infant inflammation predicts childhood emotional and behavioral problems and partially mediates socioeconomic disadvantage

BACKGROUND

Emotional and behavioral problems (EBP) are common in children. Environmental factors like socioeconomic disadvantage influence EBP pathogenesis and can trigger inflammation. However, the link between early inflammation-EBP in children is unclear. We investigated the associations between i) infant inflammatory biomarkers and subsequent EBP and ii) early life environmental factors and EBP and assessed whether infant inflammation mediated these associations.

METHODS

Inflammatory biomarkers glycoprotein acetyls (GlycA) and high-sensitivity C-reactive protein (hsCRP) were quantified at birth and 12 months in a population-derived birth cohort, the Barwon Infant Study. Early life factors including demographic, prenatal, and perinatal factors were collected from antenatal to the two-year period. Internalizing and externalizing problems at age two were measured by the Child Behavior Checklist. Prospective associations were examined by multivariable regression analyses adjusted for potential confounders. Indirect effects of early life factors on EBP through inflammation were identified using mediation analyses.

RESULTS

Elevated GlycA levels at birth (GlycAbirth) were associated with greater internalizing problems at age two (β = 1.32 per SD increase in GlycA; P = 0.001). Inflammation at birth had a stronger magnitude of effect with later EBP than at 12 months. GlycAbirth partially mediated the associations between lower household income (6%), multiparity (12%) and greater number of older siblings (13%) and EBP. Patterns were less evident for hsCRP or externalizing problems.

CONCLUSIONS

GlycAbirth was positively associated with EBP at age two and partially mediated the association between several indicators of socioeconomic disadvantage and EBP. Prenatal and perinatal inflammation may be relevant to early neurodevelopment and emotional health.

Factors associated with the follow-up of high risk infants discharged from a neonatal intensive care unit

BACKGROUND

The study aimed to identify factors associated with compliance to follow-up (FU) appointments among infants following their discharge from the neonatal intensive care unit (NICU).

METHODS

This retrospective cohort study reviewed 657 infants (birth weight <1500 g or gestational age [GA] <32 weeks), born between 2011 and 2015. A total of 525 eligible infants were classified into two groups: the compliant group (n = 360), who attended clinics from 18 to 24 months, and the non-compliant group (n = 165), who were lost to FU before 18 months.

RESULTS

The non-compliant group was more likely to have higher usage rate of assisted reproductive technology (p = 0.023), GA (p < 0.001), weight (p < 0.001), height (p < 0.001), and head circumference (p < 0.001) at birth. The sibling number was higher in the non-compliant group (p = 0.011). Moreover, the non-compliant group demonstrated higher Apgar scores at 1 min and 5 min (p = 0.002 and p = 0.031, respectively). The compliant group was more likely to live in metropolitan or larger cities with a borderline significance (p = 0.056). Furthermore, the non-compliant group was less likely to suffer from respiratory distress syndrome (p < 0.001), patent ductus arteriosus (p = 0.002), retinopathy of prematurity (p = 0.007), necrotizing enterocolitis (p = 0.019), and bronchopulmonary dysplasia (p < 0.001). Moreover, it demonstrated lower postmenstrual age at discharge (p = 0.005) and a shorter length of stay in the NICU (p < 0.001). The compliance with FU appointment varied with the assigned doctor (p < 0.001). The multivariate regression analysis mentioned that the birth weight (OR = 0.903), residence in metropolitan or larger cities (OR = 1.495), and an experience of magnetic resonance imaging (OR = 1.920) were associated with compliance. The compliance to FU appointments was different according to the assigned doctor at admission (OR = 0.357).

CONCLUSION

The birth weight, residence in metropolitan or larger cities, an experience of MRI, and the assigned doctors were associated with compliance to FU at a corrected age of 18-24 months.

Sex-specific Effect of Maternal Thyroid Hormone Trajectories on Preschoolers' Behavioral Development: A Birth Cohort Study

CONTEXT

Maternal thyroid hormone trajectories are a better predictor of offspring's neurodevelopment than hormone levels in single trimester of pregnancy. Programming effect of uterine hormonal environment on offspring's health is usually sex-specific.

OBJECTIVE

To examine the sex-specific effect of thyroid hormone trajectories on preschoolers' behavioral development.

DESIGN

Based on Ma' anshan Birth Cohort in China, pregnant women were recruited at their first antenatal checkup from May 2013 to September 2014.

SETTING

Ma' anshan Maternal and Child Health Hospital in China.

PATIENTS OR OTHER PARTICIPANTS

1860 mother-child pairs were included in the analysis. Children were followed up at age of 4.

MAIN OUTCOME MEASURES

Maternal thyroid hormones [thyroid-stimulating hormone (TSH), free thyroxine (FT4)] and thyroid peroxidase antibody in the first, second, and third trimesters of pregnancy were retrospectively assayed. Preschoolers' behavioral development was assessed by Achenbach Child Behavior Checklist/1.5~5.

RESULTS

Maternal TSH and FT4 levels were respectively fitted into high, moderate, and low trajectories. In boys, maternal high TSH trajectory was related to withdrawn [odds ratio (OR) = 2.01, 95% CI: 1.16, 3.50) and externalizing problems (OR = 2.69, 95% CI: 1.22, 5.92), and moderate TSH trajectory was associated with aggressive behavior (OR = 3.76, 95% CI: 1.16, 12.23). Maternal high FT4 trajectory was associated with anxious/depressed (OR = 2.22, 95% CI: 1.08, 4.56) and total problems (OR = 1.74, 95% CI: 1.13, 2.66), and low FT4 trajectory was associated with aggressive behavior (OR = 4.17, 95% CI: 1.22, 14.24).

CONCLUSIONS

Maternal thyroid hormone trajectories impact preschool boys' behavioral development.

Course of Stress during the Neonatal Intensive Care Unit Stay in Preterm Infants

INTRODUCTION

Understanding the course of stress during the neonatal intensive care unit stay may provide targets for interventions. Our aim was to describe the course of stress in preterm infants during the first 28 days of life, the influence of gestational age, and associations with clinical characteristics.

METHODS

In a single centre prospective cohort study, we included infants with a gestational age <30 weeks and/or birth weight <1,000 g. We measured stress over the first 28 days using the Neonatal Infant Stressor Scale (NISS). We plotted daily NISS total and subcategory scores by gestational age. The subcategories were (1) nursing, (2) skin-breaking, (3) monitoring and imaging, and (4) medical morbidity-related scores. We assessed associations of cumulative NISS scores over the first 7, 14, and 28 days with clinical characteristics using regression analyses.

RESULTS

We included 45 infants, with a median gestational age of 27 weeks. The mean daily NISS score was 66.5 (SD 8.7), with highest scores in the first 7 days of life. Scores decreased the slowest for the lowest gestational ages, in particular for nursing scores, rather than skin-breaking, monitoring and imaging, and medical morbidity-related scores. Adjusted for gestational age, infants with lower Apgar scores, sepsis, intraventricular haemorrhages, and on mechanical ventilation had significantly higher cumulative NISS scores at 7, 14, and 28 days.

CONCLUSION

NISS scores varied greatly within infants and over time, with the highest mean scores in the first week after birth. The course of declining NISS scores in the first 28 days depended on gestational age at birth.

Neonatal Stress, Health, and Development in Preterms: A Systematic Review

CONTEXT

An overview of the full range of neonatal stressors and the associated clinical, laboratory, and imaging outcomes regarding infants' health and development may contribute to the improvement of neonatal care.

OBJECTIVE

To systematically review existing literature on the associations between all kinds of neonatal stressors and the health and development of preterm infants.

DATA SOURCES

Data sources included Embase, Medline, PsycINFO, the Cumulative Index to Nursing and Allied Health Literature, and reference lists.

STUDY SELECTION

Studies were eligible if they included a measure of neonatal stress during the NICU stay, reported clinical, laboratory, and/or imaging outcomes regarding health and/or development on discharge from the NICU or thereafter, included preterm infants, and were written in English or Dutch.

DATA EXTRACTION

Two reviewers independently screened the sources and extracted data on health and development. Study quality was assessed by using the Newcastle-Ottawa Quality Assessment Scale.

RESULTS

We identified 20 articles that reported on neonatal stress associated negatively with clinical outcomes, including cognitive, motor, and emotional development, and laboratory and imaging outcomes, including epigenetic alterations, hypothalamic-pituitary-adrenal axis functioning, and structural brain development. We found no evidence regarding associations with growth, cardiovascular health, parent-infant interaction, the neonatal immune system, and the neonatal microbiome.

LIMITATIONS

The studies were all observational and used different definitions of neonatal stress.

CONCLUSIONS

Neonatal stress has a profound impact on the health and development of preterm infants, and physicians involved in their treatment and follow-up should be aware of this fact.

Altered orbitofrontal activation in preterm-born young adolescents during performance of a reality filtering task

Preterm birth is one of the main causes for neurodevelopmental problems, and has been associated with a wide range of impairments in cognitive functions including executive functions and memory. One of the factors contributing to these adverse outcomes is the intrinsic vulnerability of the premature brain. Neuroimaging studies have highlighted structural and functional alterations in several brain regions in preterm individuals across lifetime. The orbitofrontal cortex (OFC) is crucial for a multitude of complex and adaptive behaviours, and its structure is particularly affected by premature birth. Nevertheless, studies on the functional impact of prematurity on the OFC are still missing. Orbitofrontal Reality filtering (ORFi) refers to the ability to distinguish if a thought is relevant to present reality or not. It can be tested using a continuous recognition task and is mediated by the OFC in adults and typically developing young adolescents. Therefore, the ORFi task was used to investigate whether OFC functioning is affected by prematurity. We compared the neural correlates of ORFi in 35 young adolescents born preterm (below 32 weeks of gestation) and aged 10 to 14 years with 25 full term-born controls. Our findings indicate that OFC activation was required only in the full-term group, whereas preterm young adolescents did not involve OFC in processing the ORFi task, despite being able to correctly perform it.

Martins MR. Migration as a Determinant in the Development of Children Emotional and Behavior Problems: A Quantitative Study for Lisbon Region, Portugal

The role of migration as a determinant in child mental health has been demonstrated in a number of studies. However, results are not always consistent, and the research continues to be scarce, especially in Portugal. We examined the association between sociodemographic profiles and the chance for the development of emotional and behavioral difficulties in a group of 420 children, immigrant (n = 217) and born in Portugal to Portuguese born parents (n = 203). We used a structured questionnaire to obtain sociodemographic information and the Strength and Difficulties Questionnaire (SDQ). Descriptive statistics were used to characterize children and their families; variables were compared between groups using the Chi-squared, Fisher’s Exact Test, or the Mann–Whitney U test and logistic regression was used to analyze the association between socio-demographic factors and emotional and behavioral difficulties. Results showed a pattern of social and mental health inequalities with immigrant children at a disadvantage: they are more often part of families with low income and where parents had low skilled jobs. Internalizing behaviors are more frequent in immigrants than in children born in Portugal to Portuguese-born parents (p = 0.001) whereas a high total SDQ difficulties score (p = 0.039) and externalizing behaviors were more frequent in 1st generation immigrant children (p = 0.009). A low family income (aOR 4.5; 95% CI: 1.43–13.95), low parental education level (aOR 2.5; 95% CI: 1.11–5.16), and being a first-generation immigrant child (aOR 2.2; 95% CI: 1.06–4.76) increased significantly the chance of developing emotional and behavioral difficulties. This study contributes to the identification of children vulnerable to mental health problems who can benefit from monitoring, early detection and preventive interventions in order to mitigate possible negative outcomes in the future.

Disadvantaged neighborhoods, birth weight, and problem behavior in five- and six-year-old pre-school children: Evidence from a cohort born in Amsterdam

RATIONALE

Low birth weight has been found to increase the problem behavior of children. Yet, little attention has been given to adequately account for the impact of the child's neighborhood on this relation. The residential neighborhood is a choice, based on factors that are usually not observed that may also influence birth weight and problem behavior.

OBJECTIVE

Using a model that accounts for such endogeneity of both neighborhood choice and birth weight, we have analyzed behavioral problems in 4210 pre-school children between the ages of 5 and 6, birth weight, and neighborhood status, simultaneously.

METHOD

The data used are from the Amsterdam Born Children and their Development (ABCD) cohort for whom a complete prospective record of birth outcomes, pregnancy, socio-demographic characteristics, and indicators of problem behavior are available. Neighborhood data obtained from Statistics Netherlands are merged with the ABCD data file.

RESULTS

Our results suggest that ignoring endogeneity attenuates the effect of disadvantaged neighborhoods on both birth weight and problem behavior in pre-school children. Living in a disadvantaged neighborhood decreases the birth weight and increases the probability of problem behavior. Accounting for the endogeneity of neighborhood choice increases the estimated impacts (marginal effects: from -10% to -44% for birth weight and from 3% to 11% for problem behavior). Lower birth weight increases the probability of problem behavior, but it is only significant after adjusting for endogeneity. The coefficients of other factors have the expected associations with problem behavior.

CONCLUSIONS

These significant effects of disadvantaged neighborhood on birth weight and problem behavior could inform policies and practices that improve neighborhood development for children born in Amsterdam.

Trajectories of Overprotective Parenting and Hyperactivity-Impulsivity and Inattention Among Moderate-Late Preterm Children: A Population-Based Study

Parents of preterm children are more likely to adopt non-optimal parenting behaviors than parents of full-term (FT) children. However, there is a lack of studies on parents of children born moderate to late preterm (MLP; 32-36 gestational weeks). In this study, we aimed to examine: (1) the association between MLP birth status and the trajectory of parental overprotection throughout preschool years, and (2) the role of parental overprotection, MLP birth status, and their interaction in the prediction of the trajectories of hyperactivity-impulsivity and inattention throughout childhood. Data comes from a Canadian representative population-based cohort including 2028 FT, 100 MLP children, and their parents. Overprotective parenting was measured when children were 5, 17, and 29 months old. Hyperactivity-impulsivity and inattention symptoms were measured repeatedly from 4 to 8 years of age. Trajectories of parents' overprotectiveness and children's hyperactivity-impulsivity and inattention were modeled. MLP birth status was associated with an increase in parental overprotectiveness across the preschool period. MLP birth status and parental overprotection were both found to be associated with higher levels of hyperactivity-impulsivity symptoms across childhood. No interaction was found between birth status and parental overprotection. The results suggest that parents of MLP children become more overprotective across time compared to parents of FT children and that children born MLP and/or exposed to higher levels of parental overprotection demonstrated higher levels of hyperactivity-impulsivity symptoms across childhood.

Effortful control and attention as predictors of cognition in children born preterm

BACKGROUND

Preterm childbirth increases the risk of developmental problems. The aim of the present study was to examine the effects of temperament and attention on the cognition of school-age children who were born preterm, controlling for socioeconomic variables.

MATERIAL AND METHODS

The sample was composed of 50 six-year-old children who were born preterm with very low birth weight. The children were evaluated using the Wechsler Intelligence Scale for Children (WISC-III) and the Cancellation Attention Test. The mothers were interviewed using the Children's Behavior Questionnaire (CBQ). Statistical multiple linear regression analyses were performed.

RESULTS

70% of the children presented average or above-average full intellectual quotient (IQ). In the attention total score, 74% of the children were also within the average range or above. High verbal IQ associated with high maternal schooling explained 73% variability of the full IQ. High attention and maternal schooling, associated with children's temperament with more effortful control, explained 35% variability of the verbal IQ. High attention, associated with high maternal schooling and socioeconomic level, explained 37% variability of the performance IQ. The neonatal clinical variables (gestational age, birth weight, 5th-minute Apgar, and length of stay in neonatal intensive care unit (NICU) and hospital) were not predictors of cognitive outcomes.

CONCLUSION

The majority of the children who were born preterm presented average or above-average cognitive and attentional performances at school age, demonstrating potential resources for learning. Taken together, attention and temperament, associated with maternal schooling and socioeconomic status, were predictors of cognitive outcomes of children born preterm at school age.

Trajectories of behavioral problems among moderate-late preterm children from 4 to 10 years: A prospective population-based study

BACKGROUND

A growing body of research suggests that moderate to late preterm children (MLP; 32 through 36 weeks of gestation) may have higher rates of behavioral problems than full-term (FT) children. However, few studies have followed MLP children over time using a longitudinal design with repeated measures.

AIM

The current prospective longitudinal study aims to examine the relation between MLP birth and trajectories of behavioral problems among children from ages 4 to 10 years.

STUDY DESIGN AND SUBJECTS

The data comes from a Canadian representative population-based study including 1841 FT children and 89 MLP children.

OUTCOME MEASURES

Four categories of behavioral problems were measured repeatedly from 4 to 10 years using parent and teacher reports: hyperactivity-impulsivity, inattention, anxiety-depression, and aggression. Developmental trajectories were modeled using Mplus.

RESULTS

After accounting for child sex and family income, a significant and persistent association was found between MLP birth and the developmental trajectory of hyperactivity-impulsivity reported by the parent. No relation was found regarding trajectories of inattention, anxiety-depression, and aggression problems.

CONCLUSIONS

According to parent reports, MLP children were more likely to exhibit hyperactive and impulsive behaviors compared to FT peers during early childhood. However, the relation between MLP birth and the trajectory of parent-reported hyperactivity-impulsivity was small and was not confirmed by teacher evaluation. Moreover, MLP children did not differ from FT children regarding the overall trajectory of inattention, anxiety-depression, and aggression problems.

Patterns and prediction of behavior problems during the toddler and preschool periods in preterm children

There are few studies of behavior problems in preterm children prior to 2 years old and the changes that occur over time. The aims of this study were to examine the patterns and prediction of behavior problems and the effects of gender and socioeconomic status (SES) on behavior problems in preterm children at the toddler and preschool periods. Parents of 124 very low birthweight preterm children completed a standardized behavior questionnaire at 18 months corrected age and 3 years old. At both times, scores were significantly higher on Attention and Withdrawn Problems than on other behavior problem syndromes. There was a significant overall increase in Externalizing and Internalizing behavior problem scores between 18 months and 3 years, particularly in Internalizing problems. Overall prediction for normal versus not-normal categorization (≥1 standard deviation) on behavior problem and broad-spectrum scales ranged from 77% to 90% and was higher for children in the normal than not-normal categories. Boys had higher Internalizing Problems at 18 months and higher Externalizing Problems at 3 years. Children from low SES families had higher Internalizing and Total Behavior problems at 18 months and higher Internalizing, Externalizing, and Total Behavior problems at 3 years. Screening preterm children for behavior problems before 2 years old appears useful for early intervention of such problems.

Does preterm birth affect child temperament? A meta-analytic study

The present meta-analytic study was conducted to examine differences in temperament between preterm and full-term children, considering behavior style and psychobiological approaches. Moreover, we explored the potential moderators of the associations between prematurity and temperament. A systematic literature search was performed on PubMed, Scopus, Web of Science, and CINAHL. Twenty-two studies were analyzed. Preterm children showed a higher Activity level as well as lower Attentional Focusing and Attention Span/Persistence, in comparison with their full-term counterparts. Extremely preterm children showed a higher Activity level than other preterm levels. These findings support the conclusion that preterm children present with a less regulated temperament relative to those born full term.

Low weight, socioeconomics and behavioral issues: examining a population in the Northeast of Brazil

Background

Preterm and low weight children at birth are exposed to higher risks and rates of motor, cognitive, behavioral and emotional problems. Being born under low socioeconomic conditions adds even more complexity to these children. This report describes the emotional and behavioral issues of a group of children who were born in low income families and had low weigh at birth in the Northeast region of Brazil.

Method

A total of 100 children (47 with adequate and 53 with low weigh) were assessed with the Child Behavior Checklist for behavioral and emotional problems, as well as with the Autism Behavior Checklist for autism symptoms.

Results

Results show no difference between the two groups (low and adequate weight) in terms of behavior problems or autism characteristics, however, it shows elevated clinical prevalence's of behavioral and emotional problems and more vulnerability for autism symptoms when compared to the general population. Data also showed the more years children spent in pre-school, the less internalizing problems they manifested.

Conclusion

This study indicates that the impact of low socioeconomics environment is more prominent in the development of behavioral and emotional problems than low weight at birth, in addition it points to the benefits of pre-school years for the emotional and behavioral adjustment of children from low income and with low weight at birth.

Longitudinal growth and emotional and behavioral problems at age 7 in moderate and late preterms

Objectives

Moderately and late preterm children (MLPs, 32.0–36.9 weeks gestational age) have a greater risk of poorer growth. This seems to be associated with poorer neuropsychological functioning. Evidence is limited on whether this also holds for emotional and behavioral (EB) problems. Therefore, we assessed whether longitudinal growth from birth until age 7 was associated with EB problems at age 7 in MLPs.

Study design

This study was part of the Longitudinal Preterm Outcome Project, a prospective cohort study. Data on growth (height, weight, head circumference, and extent of catch-up growth) were obtained from assessments from birth until age 7. EB problems were assessed at age 7 with the Child Behavior Checklist. We assessed whether growth and EB problems were associated using logistic regression analyses, adjusting for multiple birth, parity, and socioeconomic status.

Results

We included 248 MLPs. Median gestational age was 34 weeks (interquartile range: 33–35 weeks). Mean birth weight was 2.2 kg (standard deviation: 0.5 kg). Postnatal growth measures were below the Dutch reference norm. EB problems were more prevalent in MLPs than in the general Dutch population. Generally, we found no associations between growth and EB problems; odds ratios ranged from 0.20 to 2.72.

Conclusions

In MLPs, postnatal growth from birth until age 7 was not associated with EB problems at age 7. Poorer growth thus seems to relate to neuropsychological problems, but not to EB problems. This suggests that the etiologies of these problems differ at least partially.

Socio-demographic, maternal, and child indicators of socioemotional problems in 2-year-old children: A cohort study

Throughout infancy and early childhood, stable and secure relationships with caregivers are needed to promote optimal socioemotional (SE) and cognitive development.The objective is to examine socio-demographic, maternal, and child indicators of SE problems in 2-year-olds living in an urban-suburban community in the southern United States.Mother-infant pairs enrolled in a prospective pregnancy cohort study.Shelby County (Memphis), Tennessee.One thousand five hundred three women were recruited during their second trimester and followed with their children through the child's age of 2 years.Child SE development was measured by the Brief Infant-Toddler Social Emotional Assessment at 2 years of age. Mothers reported their own behavioral and mental health, temperament, parenting stress, and potential for child abuse during gestation and/or when their child was 1 year of age. Examiners measured maternal IQ during data collection at the child's age of 1 year. Child communication, cognitive development, and risk for autism spectrum disorder were assessed at 1 and 2 years of age. Multivariable regression models were developed to predict mother-reported SE problems.In bivariate analyses, multiple maternal behavioral and mental health indicators and child cognitive skills were associated with reported child SE problems at 2 years of age. Regression analyses, controlling for socio-demographic, maternal, and child variables, showed the following factors were independently associated with mother-reported child SE problems: maternal education of high school or less, lower maternal IQ, higher maternal cyclothymic temperament score, greater parenting stress, greater maternal psychological distress, lower child expressive communication score, and child risk for autism spectrum disorder. Socio-demographic variables accounted for the variance often attributed to race.Since mothers in the study were medically low-risk, generalizing these findings to medically high-risk mothers is unwarranted. In addition, these SE outcomes in 2-year-old children do not reflect the trajectory of SE development throughout early childhood.Attention to independent indicators of future SE problems in children may help identify individual children and families needing intervention and target public prevention/treatment programs in communities.

Family Integrated Care (FICare) in Level II Neonatal Intensive Care Units: study protocol for a cluster randomized controlled trial

Background

Every year, about 15 million of the world’s infants are born preterm (before 37 weeks gestation). In Alberta, the preterm birth rate was 8.7% in 2015, the second highest among Canadian provinces. Approximately 20% of preterm infants are born before 32 weeks gestation (early preterm), and require care in a Level III neonatal intensive care unit (NICU); 80% are born moderate (32 weeks and zero days [32^0/7] to 33^6/7 weeks) and late preterm (34^0/7 to 36^6/7 weeks), and require care in a Level II NICU. Preterm birth and experiences in the NICU disrupt early parent-infant relationships and induce parental psychosocial distress. Family Integrated Care (FICare) shows promise as a model of care in Level III NICUs. The purpose of this study is to evaluate length of stay, infant and maternal clinical outcomes, and costs following adaptation and implementation of FICare in Level II NICUs.

Methods

We will conduct a pragmatic, cluster randomized controlled trial (cRCT) in ten Alberta Level II NICUs allocated to one of two groups: FICare or standard care. The FICare Alberta model involves three theoretically-based, standardized components: information sharing, parenting education, and family support. Our sample size of 181 mother-infant dyads per group is based on the primary outcome of NICU length of stay, 80% participation, and 80% retention at follow-up. Secondary outcomes (e.g., infant clinical outcomes and maternal psychosocial distress) will be assessed shortly after admission to NICU, at discharge and 2 months corrected age. We will conduct economic analysis from two perspectives: the public healthcare payer and society. To understand the utility, acceptability, and impact of FICare, qualitative interviews will be conducted with a subset of mothers at the 2-month follow-up, and with hospital administrators and healthcare providers near the end of the study.

Discussion

Results of this pragmatic cRCT of FICare in Alberta Level II NICUs will inform policy decisions by providing evidence about the clinical effectiveness and costs of FICare.

Trial registration

ClinicalTrials.gov, ID: NCT02879799. Registered on 27 May 2016. Protocol version: 9 June 2016; version 2.

Electronic supplementary material

The online version of this article (doi:10.1186/s13063-017-2181-3) contains supplementary material, which is available to authorized users.

Executive Function and Academic Outcomes in Children Who Were Extremely Preterm

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.

Temperament and behavior in toddlers born preterm with related clinical problems

OBJECTIVE

The aim of this study was to compare temperament and behavior profiles among groups of preterm toddlers differentiated by level of prematurity and the presence of bronchopulmonary dysplasia (BPD) or retinopathy of prematurity (ROP), controlling for neonatal clinical conditions and chronological age.

METHOD

The sample comprised 100 preterm toddlers segregated according to level of prematurity (75 very preterm and 25 moderate/late preterm) and presence of BPD (n=36) and ROP (n=63). Temperament was assessed by the Early Childhood Behavior Questionnaire and behavior by the Child Behavior Checklist. The MANOVA was performed with a post-hoc univariate test.

RESULTS

The level of prematurity and the presence of BPD and ROP did not affect temperament and behavioral problems in toddlers born preterm. However, the covariates age and length of stay in NICU (Neonatal Intensive Care Unit) affected temperament and behavioral problems, respectively. The older toddlers showed higher inhibitory control and lower activity levels than younger toddlers (range of 18-36months-old). Additionally, toddlers who stayed in the NICU longer showed more pervasive development and emotionally reactive problems than toddlers who stayed in NICU for less time.

CONCLUSION

The level of prematurity and the presence of bronchopulmonary dysplasia and retinopathy of prematurity did not affect temperament and behavioral problems in toddlers born preterm. However, a longer stay in the NICU increased the risk for behavioral problems, and age enhanced the regulation of temperament at toddlerhood.

Longitudinal patterns of early development in Canadian late preterm infants: A prospective cohort study

This prospective, longitudinal cohort study examined longitudinal patterns of early development in Canadian children born late preterm. A convenience sample of 82 mothers and their healthy, singleton, late preterm children participated. Mothers completed the Ages and Stages Questionnaires at 4, 8, and 18 months corrected age. Concerns were most commonly reported in the communication and gross motor domains, especially early in development. The proportion of children scoring below the referral cut-off in at least one domain at 4, 8, and 18 months was, respectively, 25.6, 25.6, and 14.6%. Only two children (2.4%) scored below referral cut-off in at least one domain at all three time points. At ages four and eight months, the late preterm sample had significantly lower communication and gross motor scores than the Ages and Stages Questionnaires normative sample. At age four months, there was also a significant difference on the fine motor domain. There were no significant differences at age 18 months. Healthy late preterm children appear to catch up to population norms by age 18 months corrected age. Longer term studies are needed to further clarify early indicators of delay in late preterm children and identity those who require close developmental monitoring.