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De Leeuw S, Delens G, Vanden Brande L, Henrion E, Legros L. Socio-familial environment influence on cognitive and language development in very preterm children. Child Care Health Dev 2024; 50:e13239. [PMID: 38413377 DOI: 10.1111/cch.13239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/25/2024] [Accepted: 02/06/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND Preterm children are at increased risk of cognitive and language delay compared with term-born children. While many perinatal factors associated with prematurity are well established, there is limited research concerning the influence of the socio-familial environment on the development of preterm children. This study aims to assess the relative impact of perinatal and socio-familial risk factors on cognitive and language development at 2 years corrected age (CA). METHOD This retrospective cross-sectional study included preterm infants with a gestational age <32 weeks and/or a birth weight <1500 g, who underwent neurodevelopmental assessment at 2 years CA. Cognitive and language scores were assessed using the Bayley Scales of Infant-Toddler Development, third edition. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were calculated using a multivariable model to examine the relationship between developmental delays and perinatal and socio-familial factors. RESULT The prevalence of language delay was negatively associated with daycare attendance (aOR: 0.25, 95% CI: 0.07-0.85, p < 0.05) and high maternal educational levels (aOR: 0.24, 95% CI: 0.05-0.93, p < 0.05) and positively associated with bilingual environments (aOR: 5.62, 95% CI: 1.46-24.3, p < 0.05). Perinatal and postnatal risk factors did not show a significant impact on cognitive or language development. CONCLUSION The development of language appears to be more influenced by the socio-familial environment than by early perinatal and postnatal factors associated with prematurity. These findings highlight the importance of considering socio-familial factors in the early identification and intervention of language delay among preterm children.
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Affiliation(s)
- Stéphanie De Leeuw
- Department of Neonatal Intensive Care, CHR Sambre et Meuse, Namur, Belgium
| | - Gilda Delens
- Department of Neonatal Intensive Care, CHR Sambre et Meuse, Namur, Belgium
- Follow-up Center for Preterm Infants, CHR Sambre et Meuse, Namur, Belgium
| | - Laura Vanden Brande
- Follow-up Center for Preterm Infants, CHR Sambre et Meuse, Namur, Belgium
- Department of Pediatric Neurology, Centre Hospitalier Universitaire de Liège, Liège, Belgium
| | - Elisabeth Henrion
- Department of Neonatal Intensive Care, CHR Sambre et Meuse, Namur, Belgium
| | - Ludovic Legros
- Follow-up Center for Preterm Infants, CHR Sambre et Meuse, Namur, Belgium
- Department of Neonatal Intensive Care, CHIREC-Delta Hospital, Brussels, Belgium
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Tamm L, McNally KA, Altaye M, Parikh NA. Mathematics abilities associated with adaptive functioning in preschool children born preterm. Child Neuropsychol 2024; 30:315-328. [PMID: 36939102 PMCID: PMC10509309 DOI: 10.1080/09297049.2023.2191942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 03/10/2023] [Indexed: 03/21/2023]
Abstract
It is well known that infants born very preterm (VPT) often demonstrate deficits in mathematical abilities in early childhood which are associated with poorer academic outcomes. Mathematic skills are also critical for other areas of functioning. However, it is not known whether mathematics skills are associated with adaptive functioning in children born preterm. Infants born at ≤31 weeks gestation and full term were recruited at birth and followed over time. At the 36-month corrected age assessment, children were administered the Early Number Concepts subtest of the Differential Abilities Scale, Second Edition, and caregivers completed the Adaptive Behavior Assessment System, Third Edition. After controlling for age, sex, cognitive abilities, and caregiver education, performance on the mathematics measure was uniquely and positively associated with adaptive behavior for preschool children in the VPT group only. Exploratory analyses revealed this association to be specifically related to the Practical and Social composites. Knowledge of concepts of number and quantity were associated with better adaptive functioning, particularly for behaviors related to functioning at home and in the community and play/social functioning, for children born VPT. Although replication is warranted, it would appear that mathematical skills may be an important early intervention target for children born VPT.
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Affiliation(s)
- Leanne Tamm
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, Ohio 45229-3039
- University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | - Mekibib Altaye
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, Ohio 45229-3039
- University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Nehal A. Parikh
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, Ohio 45229-3039
- University of Cincinnati College of Medicine, Cincinnati, Ohio
- The Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
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3
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Rapuc S, Pierrat V, Marchand-Martin L, Benhammou V, Kaminski M, Ancel PY, Twilhaar ES. The interrelatedness of cognitive abilities in very preterm and full-term born children at 5.5 years of age: a psychometric network analysis approach. J Child Psychol Psychiatry 2024; 65:18-30. [PMID: 37165961 DOI: 10.1111/jcpp.13816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/14/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND Very preterm (VP) birth is associated with a considerable risk for cognitive impairment, putting children at a disadvantage in academic and everyday life. Despite lower cognitive ability on the group level, there are large individual differences among VP born children. Contemporary theories define intelligence as a network of reciprocally connected cognitive abilities. Therefore, intelligence was studied as a network of interrelated abilities to provide insight into interindividual differences. We described and compared the network of cognitive abilities, including strength of interrelations between and the relative importance of abilities, of VP and full-term (FT) born children and VP children with below-average and average-high intelligence at 5.5 years. METHODS A total of 2,253 VP children from the EPIPAGE-2 cohort and 578 FT controls who participated in the 5.5-year-follow-up were eligible for inclusion. The WPPSI-IV was used to measure verbal comprehension, visuospatial abilities, fluid reasoning, working memory, and processing speed. Psychometric network analysis was applied to analyse the data. RESULTS Cognitive abilities were densely and positively interconnected in all networks, but the strength of connections differed between networks. The cognitive network of VP children was more strongly interconnected than that of FT children. Furthermore, VP children with below average IQ had a more strongly connected network than VP children with average-high IQ. Contrary to our expectations, working memory had the least central role in all networks. CONCLUSIONS In line with the ability differentiation hypothesis, children with higher levels of cognitive ability had a less interconnected and more specialised cognitive structure. Composite intelligence scores may therefore mask domain-specific deficits, particularly in children at risk for cognitive impairments (e.g., VP born children), even when general intelligence is unimpaired. In children with strongly and densely connected networks, domain-specific deficits may have a larger overall impact, resulting in lower intelligence levels.
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Affiliation(s)
- S Rapuc
- Université Paris Cité, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), INSERM, INRAE, Paris, France
| | - V Pierrat
- Université Paris Cité, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), INSERM, INRAE, Paris, France
- Department of Neonatology, Centre Hospitalier Intercommunal Créteil, Créteil, France
| | - L Marchand-Martin
- Université Paris Cité, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), INSERM, INRAE, Paris, France
| | - V Benhammou
- Université Paris Cité, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), INSERM, INRAE, Paris, France
| | - M Kaminski
- Université Paris Cité, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), INSERM, INRAE, Paris, France
| | - P-Y Ancel
- Université Paris Cité, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), INSERM, INRAE, Paris, France
- Assistance Publique-Hôpitaux de Paris, Clinical Investigation Centre P1419, Paris, France
| | - E S Twilhaar
- Université Paris Cité, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), INSERM, INRAE, Paris, France
- Department of Psychology, University of Warwick, Coventry, UK
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Kurul Ş, Beckers FLM, Vermeulen MJ, Suurland J, Hasbek JE, Ramakers CRB, Simons SHP, Reiss IKM, Taal HR. Inflammation, sepsis severity and neurodevelopmental outcomes of late-onset sepsis in preterm neonates. Pediatr Res 2023; 94:2026-2032. [PMID: 37468719 DOI: 10.1038/s41390-023-02742-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 04/15/2023] [Accepted: 07/03/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND The aim of this study was to investigate the association between inflammatory biomarkers (C-reactive protein (CRP), procalcitonin (PCT) and interleukin-6 (IL-6)) and sepsis severity (neonatal-Sequential-Organ-Failure-Assessment (nSOFA)) and neurodevelopmental outcomes at 2 years, among very preterm neonates. METHODS Data on preterm neonates (gestational age <30 weeks) from 2016 until 2020 were reviewed. Outcomes of interest were NDI (no, mild, severe) and the motor and cognitive score on the Dutch-Bayley-Scales-of-Infant-and-Toddler-Development (Bayley-III-NL) assessed at the corrected age of 2 years. Logistic and linear regression analysis were used for categorical and continuous outcomes, respectively. All analyses were adjusted for gestational age, sex and birthweight-for-gestational-age SD-score. RESULTS In total 410 patients were eligible for analysis. Maximum CRP concentrations were associated with lower motor and cognitive scores (effect estimate -0.03 points,(95% CI -0.07; -0.00) and -0.03 points,(95% CI -0.06; -0.004), respectively) and increased risk of severe NDI (odds ratio (OR) 1.01, (95% CI 1.00; 1.01)). High nSOFA scores (≥4) during sepsis episodes were associated with an increased risk of mild NDI (OR 2.01, (95% CI 1.34; 3.03)). There were no consistent associations between IL-6, PCT and the outcomes of interest. CONCLUSION High CRP concentrations and sepsis severity in preterm neonates seem to be associated with neurodevelopmental outcomes in survivors at the age of 2 years. IMPACT STATEMENT The level of inflammation and sepsis severity are associated with neurodevelopmental outcome in preterm neonates at 2 years of corrected age. Sepsis is a major health issue in preterm neonates and can lead to brain damage and impaired neurodevelopment. Biomarkers can be determined to assess the level of inflammation. However, the relation of inflammatory biomarkers with neurodevelopmental outcome is not known. The level of inflammation and sepsis severity are related to neurodevelopmental outcome in preterm neonates. Maximum CRP concentration and high nSOFA scores are associated with an increased risk of neurodevelopmental impairment in survivors at the corrected age of 2 years.
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Affiliation(s)
- Şerife Kurul
- Department of Neonatal and Pediatric Intensive Care, Division of Neonatology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Famke L M Beckers
- Department of Neonatal and Pediatric Intensive Care, Division of Neonatology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Marijn J Vermeulen
- Department of Neonatal and Pediatric Intensive Care, Division of Neonatology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Jill Suurland
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Jasmin E Hasbek
- Department of Neonatal and Pediatric Intensive Care, Division of Neonatology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands
| | | | - Sinno H P Simons
- Department of Neonatal and Pediatric Intensive Care, Division of Neonatology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Irwin K M Reiss
- Department of Neonatal and Pediatric Intensive Care, Division of Neonatology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - H Rob Taal
- Department of Neonatal and Pediatric Intensive Care, Division of Neonatology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands.
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Lowe J, Bann CM, Dempsey AG, Fuller J, Taylor HG, Gustafson KE, Watson VE, Vohr BR, Das A, Shankaran S, Yolton K, Ball MB, Hintz SR. Do Bayley-III Composite Scores at 18-22 Months Corrected Age Predict Full-Scale IQ at 6-7 Years in Children Born Extremely Preterm? J Pediatr 2023; 263:113700. [PMID: 37640232 PMCID: PMC10840976 DOI: 10.1016/j.jpeds.2023.113700] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/31/2023] [Accepted: 08/22/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVE To determine the ability of the Bayley-III cognitive and language composite scores at 18-22 months corrected age to predict WISC-IV Full Scale IQ (FSIQ) at 6-7 years in infants born extremely preterm. STUDY DESIGN Children in this study were part of the Neuroimaging and Neurodevelopmental Outcome cohort, a secondary study to the SUPPORT trial and born 240/7-276/7 weeks gestational age. Bayley-III cognitive and language scores and WISC-IV FSIQ were compared with pairwise Pearson correlation coefficients and adjusted for medical and socioeconomic variables using linear mixed effect regression models. RESULTS Bayley-III cognitive (r = 0.33) and language scores (r = 0.44) were mildly correlated with WISC-IV FSIQ score. Of the children with Bayley-III cognitive scores of <70, 67% also had FSIQ of <70. There was less consistency for children with Bayley-III scores in the 85-100 range; 43% had an FSIQ of <85 and 10% an FSIQ of <70. Among those with Bayley-III language scores >100, approximately 1 in 5 had an FSIQ of <85. A cut point of 92 for the cognitive composite score resulted in sensitivity (0.60), specificity (0.64). A cut point of 88 for the language composite score produced sensitivity (0.61), specificity (0.70). CONCLUSIONS Findings indicate the Bayley-III cognitive and language scores correlate with later IQ, but may fail to predict delay or misclassify children who are not delayed at school age. The Bayley-III can be a useful tool to help identify children born extremely preterm who have below average cognitive scores and may be at the greatest risk for ongoing cognitive difficulties. TRIAL REGISTRATION Extended Follow-up at School Age for the SUPPORT Neuroimaging and Neurodevelopmental Outcomes (NEURO) Cohort: NCT00233324.
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Affiliation(s)
- Jean Lowe
- Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, NM
| | - Carla M Bann
- Social, Statistical and Environmental Sciences Unit, RTI International, Research Triangle Park, NC
| | - Allison G Dempsey
- Department of Psychiatry, University of Colorado School of Medicine, University of Colorado Hospital, Denver, CO
| | - Janell Fuller
- Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, NM.
| | - H Gerry Taylor
- Department of Pediatrics, Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, OH
| | - Kathryn E Gustafson
- Department of Pediatrics, Abigail Wexner Research Institute at Nationwide Children's Hospital, The Ohio State University, Columbus, OH
| | | | - Betty R Vohr
- Department of Pediatrics, Duke University, Durham, NC
| | - Abhik Das
- Department of Pediatrics, Women & Infants Hospital, Brown University, Providence, RI
| | - Seetha Shankaran
- Social, Statistical and Environmental Sciences Unit, RTI International, Rockville, MD
| | - Kimberly Yolton
- Department of Pediatrics, Wayne State University, Detroit, MI
| | - M Bethany Ball
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Susan R Hintz
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA
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Joseph RM, Hooper SR, Heeren T, Santos HP, Frazier JA, Venuti L, Foley A, Rollins CK, Kuban KCK, Fry RC, O’Shea TM. Maternal Social Risk, Gestational Age at Delivery, and Cognitive Outcomes among Adolescents Born Extremely Preterm. Paediatr Perinat Epidemiol 2022; 36:654-664. [PMID: 36530363 PMCID: PMC9754639 DOI: 10.1111/ppe.12893] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 04/22/2022] [Indexed: 01/09/2023]
Abstract
Background Children born extremely preterm (EP) are at increased risk of cognitive deficits that persist into adulthood. Few large cohort studies have examined differential impairment of cognitive function in EP-born adolescents in relation to early life risk factors, including maternal social disadvantage, gestational age at delivery, and neonatal morbidities prevalent among EP neonates. Objectives To assess cognitive abilities in relation to early life risk factors in an EP-born cohort at 15 years of age. Methods 681 of 1198 surviving participants (57%) enrolled from 2002 to 2004 in the Extremely Low Gestational Age Newborn Study returned at age 15 years for an assessment of cognitive abilities with the Wechsler Abbreviated Scale of Intelligence-II and the NIH Toolbox Cognition Battery (NTCB) verbal cognition and fluid processing composites, the latter of which measured executive functions and processing speed. Three cognitive outcomes, WASI-II IQ, NTCB verbal cognition, and NTCB fluid processing, were analyzed for associations with maternal social disadvantage and gestational age. Mediation of maternal social disadvantage by gestational age and mediation of gestational age by neonatal morbidities were also examined. Results Test scores were lower for NTCB fluid processing relative to IQ and NTCB verbal abilities. Social disadvantage and gestational age were associated with all three cognitive outcomes. Mediation analyses indicated partial mediation of gestational age associations with all three outcomes by neonatal morbidities but did not support mediation by gestational age of social risk associations with cognitive outcomes. Conclusions Greater maternal social disadvantage and lower gestational age are associated with less favorable cognitive outcomes among EP-born adolescents at 15 years of age. Neonatal morbidities partially mediate associations between lower gestational age and cognitive outcomes. These findings highlight the need for improved medical and remedial interventions to mitigate risk of poor cognitive outcomes among EP-born adolescents.
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Affiliation(s)
- Robert M. Joseph
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, USA
| | - Stephen R. Hooper
- Department of Allied Health Sciences, School of Medicine, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Tim Heeren
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Hudson P. Santos
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL, USA
| | - Jean A. Frazier
- Eunice Kennedy Shriver Center, University of Massachusetts Medical School, Worcester, MA, USA
| | - Lauren Venuti
- Eunice Kennedy Shriver Center, University of Massachusetts Medical School, Worcester, MA, USA
| | - Ann Foley
- Eunice Kennedy Shriver Center, University of Massachusetts Medical School, Worcester, MA, USA
| | - Caitlin K. Rollins
- Department of Neurology, Boston Children’s Hospital/Harvard Medical School, Boston, MA, USA
| | - Karl C. K. Kuban
- Department of Pediatrics, Boston Medical Center, Boston, MA, USA
| | - Rebecca C. Fry
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Thomas M. O’Shea
- Department of Pediatrics, University of North Carolina, Chapel Hill, NC, USA
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Lee HC, Lyell DJ. Active Treatment and Shared Decision-making for Infants Born Extremely Preterm at 22 to 25 Weeks. JAMA 2022; 328:624-626. [PMID: 35972504 DOI: 10.1001/jama.2022.13364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Henry C Lee
- Division of Neonatology, Department of Pediatrics, Stanford School of Medicine, Stanford, California
| | - Deirdre J Lyell
- Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, Stanford School of Medicine, Stanford, California
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Trickett J, Bernardi M, Fahy A, Lancaster R, Larsen J, Ni Y, Suonpera E, Wolke D, Marlow N, Johnson S. Neuropsychological abilities underpinning academic attainment in children born extremely preterm. Child Neuropsychol 2022; 28:746-767. [PMID: 35021954 DOI: 10.1080/09297049.2021.2014433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 11/29/2021] [Indexed: 10/19/2022]
Abstract
Children born extremely preterm (EP) have poorer academic attainment than their term-born peers. There is a need to identify the specific cognitive mechanisms that are associated with poor academic attainment in preterm populations to inform the development of intervention strategies. A parallel mediation analysis was conducted with cross-sectional data from 152 EP children (< 27 weeks of gestation) and 120 term-born controls who were assessed at age 11. Mathematics and reading attainment was assessed using the Wechsler Individual Achievement Test 2nd Edition. Controlling for sex and socio-economic status we evaluated the following mediators: verbal working memory, visuospatial working memory, verbal processing speed, attention, and visuospatial processing. These were assessed using subtests from the standardized NEPSY-II test and Wechsler Intelligence Scale for Children-5th Edition. Verbal working memory, visuospatial working memory, visuospatial processing and verbal processing speed, but not attention, were significant independent mediators between EP birth and attainment in reading. No direct relationship between EP birth and reading attainment remained in the mediated model. All five neuropsychological variables mediated the relationship between EP birth and attainment in mathematics, but a direct effect of EP birth on mathematics remained in the mediated model. Together, all five neuropsychological abilities indirectly explained 44% of the variance in reading and 52% of the variance in mathematics. Visuospatial processing was the strongest mediator of both mathematics and reading. Components of executive function, especially visuospatial processing, are important predictors of academic attainment. Interventions to improve visuospatial skills could be trialed in EP populations.
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Affiliation(s)
- Jayne Trickett
- Department of Health Sciences, University of Leicester, Leicester, UK
| | | | - Amanda Fahy
- Institute for Women's Health, University College London, London, UK
| | - Rebecca Lancaster
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Jennifer Larsen
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Yanyan Ni
- Institute for Women's Health, University College London, London, UK
| | - Emmi Suonpera
- Institute for Women's Health, University College London, London, UK
| | - Dieter Wolke
- Department of Psychology, University of Warwick, Coventry, UK
| | - Neil Marlow
- Institute for Women's Health, University College London, London, UK
| | - Samantha Johnson
- Department of Health Sciences, University of Leicester, Leicester, UK
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9
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Haffner DN, Sankovic A. A Neurologist's Guide to Neonatal Neurodevelopmental Assessments and Preterm Brain Injury. Semin Pediatr Neurol 2022; 42:100974. [PMID: 35868724 DOI: 10.1016/j.spen.2022.100974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/14/2022] [Accepted: 04/14/2022] [Indexed: 11/19/2022]
Abstract
Despite advances in medical care and improved survival of extremely preterm infants, rates of neurodevelopmental impairment remain high. Outcomes are significantly improved with early intervention, but infants must be appropriately identified to facilitate services. Neuroimaging provides important information regarding neurodevelopmental outcomes but prognosticating and communicating risk remains challenging. Standardized neonatal neurodevelopmental assessments provide supplemental information to aid in the identification of high-risk infants and counseling for their families.
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Affiliation(s)
- Darrah N Haffner
- Division of Pediatric Neurology, Nationwide Children's Hospital and the Ohio State University, 700 Children's Dr Columbus, 43205 OH, United States.
| | - Alexandra Sankovic
- Division of Pediatric Neurology, Nationwide Children's Hospital and the Ohio State University, 700 Children's Dr Columbus, 43205 OH, United States
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Liu W, Sun Q, Huang L, Bhattacharya A, Wang GW, Tan X, Kuban KCK, Joseph RM, O'Shea TM, Fry RC, Li Y, Santos HP. Innovative computational approaches shed light on genetic mechanisms underlying cognitive impairment among children born extremely preterm. J Neurodev Disord 2022; 14:16. [PMID: 35240980 PMCID: PMC8903548 DOI: 10.1186/s11689-022-09429-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 02/22/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Although survival rates for infants born extremely preterm (gestation < 28 weeks) have improved significantly in recent decades, neurodevelopmental impairment remains a major concern. Children born extremely preterm remain at high risk for cognitive impairment from early childhood to adulthood. However, there is limited evidence on genetic factors associated with cognitive impairment in this population. METHODS First, we used a latent profile analysis (LPA) approach to characterize neurocognitive function at age 10 for children born extremely preterm. Children were classified into two groups: (1) no or low cognitive impairment, and (2) moderate-to-severe cognitive impairment. Second, we performed TOPMed-based genotype imputation on samples with genotype array data (n = 528). Third, we then conducted a genome-wide association study (GWAS) for LPA-inferred cognitive impairment. Finally, computational analysis was conducted to explore potential mechanisms underlying the variant x LPA association. RESULTS We identified two loci reaching genome-wide significance (p value < 5e-8): TEA domain transcription factor 4 (TEAD4 at rs11829294, p value = 2.40e-8) and syntaxin 18 (STX18 at rs79453226, p value = 1.91e-8). Integrative analysis with brain expression quantitative trait loci (eQTL), chromatin conformation, and epigenomic annotations suggests tetraspanin 9 (TSPAN9) and protein arginine methyltransferase 8 (PRMT8) as potential functional genes underlying the GWAS signal at the TEAD4 locus. CONCLUSIONS We conducted a novel computational analysis by utilizing an LPA-inferred phenotype with genetics data for the first time. This study suggests that rs11829294 and its LD buddies have potential regulatory roles on genes that could impact neurocognitive impairment for extreme preterm born children.
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Affiliation(s)
- Weifang Liu
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Quan Sun
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Le Huang
- Curriculum in Bioinformatics and Computational Biology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Arjun Bhattacharya
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Geoffery W Wang
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Xianming Tan
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Karl C K Kuban
- Department of Pediatrics, Boston University, Boston, MA, USA
| | - Robert M Joseph
- Department of Anatomy & Neurobiology, Boston University, Boston, MA, USA
| | - T Michael O'Shea
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rebecca C Fry
- Department of Environmental Sciences and Engineering, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Yun Li
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Department of Computer Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Hudson P Santos
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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11
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Liu GXH, Harding JE. Caregiver-reported health-related quality of life of New Zealand children born very and extremely preterm. PLoS One 2021; 16:e0253026. [PMID: 34101760 PMCID: PMC8186812 DOI: 10.1371/journal.pone.0253026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 05/26/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Children born preterm, particularly at earlier gestations, are at increased risk for mortality and morbidity, but later health-related quality of life (HRQoL) is less well described. Neurodevelopmental impairment and socio-economic status may also influence HRQoL. Our aim was to describe the HRQoL of a cohort of New Zealand children born very and extremely preterm, and how this is related to neurodevelopmental impairment, gestational age, and socio-economic deprivation. METHODS Children born <30 weeks' gestation or <1500 g birthweight were assessed at 7 years' corrected age. Caregivers completed the Child Health Questionnaire Parent Form (CHQ-PF50), and the Health Utilities Index Mark 2 (HUI-2). Neurodevelopmental impairment was defined as Wechsler full scale intelligence quotient below -1 standard deviation (SD), Movement Assessment Battery for Children total score ≤15 percentile, cerebral palsy, deafness, or blindness. RESULTS Data were collected for 127 children, of whom 60 (47%) had neurodevelopmental impairment. Overall, HRQoL was good: mean (SD) CHQ-PF50 physical summary score = 50.8 (11.1), psychosocial summary score = 49.3 (9.1) [normative mean 50 (10)]; HUI-2 dead-healthy scale = 0.92 (0.09) [maximum 1.0]. Neurodevelopmental impairment, lower gestational age, and higher socio-economic deprivation were all associated with reduced HRQoL. However, on multivariable analysis, only intelligence quotient and motor function were associated with psychosocial HRQoL, while intelligence quotient was associated with physical HRQoL. CONCLUSIONS Most seven-year-old children born very and extremely preterm have good HRQoL. Further improvements will require reduced neurodevelopmental impairment.
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Affiliation(s)
- Gordon X. H. Liu
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Jane E. Harding
- Liggins Institute, University of Auckland, Auckland, New Zealand
- * E-mail:
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12
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Nist MD, Pickler RH, Harrison TM, Steward DK, Shoben AB. Inflammatory predictors of neurobehavior in very preterm infants. Early Hum Dev 2020; 147:105078. [PMID: 32492526 PMCID: PMC7363528 DOI: 10.1016/j.earlhumdev.2020.105078] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 03/29/2020] [Accepted: 05/18/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Preterm infants are at risk for impaired neurodevelopment. Inflammation may be an important modifiable mediator of preterm birth and neurodevelopmental impairment, but few studies have examined longitudinal measures of inflammation. OBJECTIVE To determine the relationship between longitudinal measures of inflammation and neurobehavior in very preterm infants. STUDY DESIGN Non-experimental, repeated measures cohort study. METHODS Very preterm infants were enrolled between October 2017 and December 2018. Blood was collected weekly until 35 weeks post-menstrual age for the quantification of plasma cytokines. Neurobehavior was assessed at 35 weeks post-menstrual age using the cluster scores for motor development and vigor and alertness/orientation from the Neurobehavioral Assessment of the Preterm Infant. Multiple linear regression models with robust standard errors were used to analyze the data. Average levels of individual cytokines, cytokine trends, and composite scores were used as measures of inflammation. RESULTS Seventy-three infants were enrolled in the study. Interleukin-1 receptor antagonist was associated with motor development and vigor scores. Interleukin-6 was associated with alertness/orientation scores. Tumor necrosis factor-alpha and composite scores of inflammation were associated with motor development and vigor and alertness/orientation scores. There were interactions with post-menstrual age at birth and infant sex. CONCLUSION Inflammation may be an important predictor of short-term neurobehavior in preterm infants. Interleukin-1 receptor antagonist, interleukin-6, and tumor necrosis factor-alpha are key cytokines for studies of preterm infants, but composite scores may be a better measure of inflammation than individual cytokines. Inflammation can be damaging to the immature brain and may be a specific target for future interventions to improve outcomes.
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Affiliation(s)
- Marliese Dion Nist
- The Ohio State University, College of Nursing, 1585 Neil Avenue, Columbus, OH 43210, USA.
| | - Rita H Pickler
- The Ohio State University, College of Nursing, 1585 Neil Avenue, Columbus, OH 43210, USA.
| | - Tondi M Harrison
- The Ohio State University, College of Nursing, 1585 Neil Avenue, Columbus, OH 43210, USA.
| | - Deborah K Steward
- The Ohio State University, College of Nursing, 1585 Neil Avenue, Columbus, OH 43210, USA.
| | - Abigail B Shoben
- The Ohio State University, College of Public Health, Division of Biostatistics, 1841 Neil Avenue, Columbus, OH 43210, USA.
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13
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Lowe J, Bann CM, Fuller J, Vohr BR, Hintz SR, Das A, Higgins RD, Watterberg KL. Early working memory is a significant predictor of verbal and processing skills at 6-7 years in children born extremely preterm. Early Hum Dev 2020; 147:105083. [PMID: 32504881 PMCID: PMC7384388 DOI: 10.1016/j.earlhumdev.2020.105083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 04/22/2020] [Accepted: 05/20/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The study was designed to investigate whether attainment of object permanence, a measure of early working memory used at 18-22 months corrected age, was associated with executive function at 6-7 years in a cohort of children born extremely preterm. STUDY DESIGN Children enrolled in the Neuroimaging and Neurodevelopmental Outcome (NEURO) study, a secondary study to the Surfactant Positive Airway Pressure and Pulse Oximetry Trial (SUPPORT) of the NICHD NRN, were eligible for this longitudinal study. Testing completed at 18 to 22 months corrected age was compared to testing at school age with a specific focus on measures of executive function. RESULTS Children who had achieved object permanence mastery at a corrected age of 18-22 months had higher mean scores on the WISC-IV tests of verbal comprehension and processing speed at age 6-7 years. Regression models indicated that object permanence scores were significant predictors of both verbal comprehension and processing speeds scores, after controlling for other factors. When analyzed by subgroup for sex, these results were significant for girls but not for boys. CONCLUSIONS This study found that an early mastery of object permanence was associated with higher scores in areas of verbal comprehension and processing speed in girls. These results have implications for potentially identifying young children born preterm that are at greater risk for difficulties with cognitive and working memory skills at school age.
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Affiliation(s)
- Jean Lowe
- University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Carla M Bann
- Social, Statistical and Environmental Sciences Unit, RTI International, Research Triangle Park, NC, USA
| | - Janell Fuller
- University of New Mexico Health Sciences Center, Albuquerque, NM, USA.
| | - Betty R Vohr
- Department of Pediatrics, Women & Infants Hospital, Brown University, Providence, RI, USA
| | - Susan R Hintz
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, USA
| | - Abhik Das
- Social, Statistical and Environmental Sciences Unit, RTI International, Bethesda, MD, USA
| | - Rosemary D Higgins
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
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14
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15
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Abstract
Social problems are an important feature of the preterm behavioral phenotype but are diverse and multidimensional. A model of social competence comprised of the three interrelated components of social cognition, social interaction, and social adjustment is useful in conceptualizing these problems. Weaknesses in social cognition in very preterm (VPT) children, although rarely studied, are found on tasks involving interpretation of social cues. Difficulties in social interaction in VPT infants and young children are documented by structured observations of their interactions with adults. Problems in social adjustment are endorsed on parent and teacher ratings of VPT infants and youth and on self-reports of VPT adults. These multiple deficits likely stem from early disruptions in neural development, are related to other consequences of preterm birth, and subject to postnatal environment influences. Further research is needed to more fully account for the effects of VPT birth on the development of social competence.
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Affiliation(s)
- H Gerry Taylor
- Abigail Wexner Research Institute at Nationwide Children's Hospital and The Ohio State University, Columbus, OH, USA.
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16
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Buil A, Sankey C, Caeymaex L, Apter G, Gratier M, Devouche E. Fostering mother-very preterm infant communication during skin-to-skin contact through a modified positioning. Early Hum Dev 2020; 141:104939. [PMID: 31855717 DOI: 10.1016/j.earlhumdev.2019.104939] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 11/12/2019] [Accepted: 12/10/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Skin-to-skin contact (SSC) has been widely studied in NICU and several meta-analyses have looked at its benefits both for the baby and the parent. Very few studies however have investigated benefit for communication. AIMS Investigate the immediate benefits of Supported Diagonal Flexion (SDF) positioning during SSC on the quality of mother - very-preterm infant communication and to gain insight into how mothers' and very-preterm infants' communicative behaviours are coordinated in time just a few days after birth. SUBJECTS AND STUDY DESIGN Monocentric prospective matched-pair case-control study. Thirty-four mothers and their very preterm infants (27 to 31 + 6 weeks GA; mean age at birth 30: weeks GA) were assigned to one of the two SSC positioning, either the Vertical Control (n = 17) or the SDF Intervention positioning (n = 17). Mother and infant were filmed during the first 5 min of SSC, 15 days after the very first SSC (i.e. 18 days after very premature birth, i.e. on average 32.4 weeks GA). OUTCOME MEASURES Infants' state of consciousness according to the Assessment of Preterm Infants' Behavior scale. Onset and duration of infants' and mothers' smiles, gazes and vocalizations, and their temporal proximity inside a 1-sec time-window. RESULTS In the SDF Intervention Group, very preterm infants vocalized three times more and mothers vocalized, gazed at their baby's face, and smiled more than in the Vertical Control Group. Moreover, in a one-second time-frame, temporal proximity of mother-infant behaviours was greater in the SDF Intervention Group. CONCLUSIONS Our study shows that SDF positioning creates more opportunities for mother-infant communication during SSC. SDF positioning fosters a greater multimodal temporal proximity thus supporting a more qualitative mother-infant communication.
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Affiliation(s)
- Aude Buil
- Université Paris Descartes, Laboratoire de Psychopathologie et Processus de Santé (LPPS EA4057), France.
| | - Carole Sankey
- Université Paris Descartes, Laboratoire de Psychopathologie et Processus de Santé (LPPS EA4057), France.
| | - Laurence Caeymaex
- Service de réanimation et médecine néonatale, CHI Créteil, Ceditec UPEC, France.
| | - Gisèle Apter
- Service de pédopsychiatrie universitaire, Groupe Hospitalier du Havre, France.
| | - Maya Gratier
- Université Paris Nanterre, Laboratoire Ethologie Cognition Développement (LECD EA3456), France.
| | - Emmanuel Devouche
- Université Paris Descartes, Laboratoire de Psychopathologie et Processus de Santé (LPPS EA4057), France; Service de pédopsychiatrie universitaire, Groupe Hospitalier du Havre, France.
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17
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Cameron KL, McGinley JL, Allison K, Fini NA, Cheong JLY, Spittle AJ. Dance PREEMIE, a Dance PaRticipation intervention for Extremely prEterm children with Motor Impairment at prEschool age: an Australian feasibility trial protocol. BMJ Open 2020; 10:e034256. [PMID: 31988234 PMCID: PMC7044943 DOI: 10.1136/bmjopen-2019-034256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Children born extremely preterm (EP: <28 weeks gestation) and/or extremely low birth weight (ELBW: <1000 g) are at increased risk of motor impairment compared with children born at term. Children with motor impairment have lower rates of physical activity (PA) participation compared with their typically developing peers. PA participation is an important outcome for children with motor impairment, however, there is limited evidence available to support interventions that improve PA participation in this population. The aim of this study is to assess the feasibility, including the recruitment and retention, acceptability and fidelity, of a preschool dance participation intervention for children born EP/EBLW with motor impairment called Dance PaRticipation intervention for Extremely prEterm children with Motor Impairment at prEschool age. METHODS AND ANALYSIS This feasibility case series trial will recruit EP/ELBW children with motor impairment (n=10) from the Victorian Infant Collaborative Study 2016/2017 cohort, a prospective longitudinal cohort study. Up to 10 community-based dance teachers will be recruited and provided with physiotherapy-led training and support to facilitate the participation of EP/ELBW children in community dance classes. A mixed-methods approach (quantitative and qualitative) will be used to analyse the primary aim, to determine the feasibility of the intervention from the perspectives of families and dance teachers. ETHICS AND DISSEMINATION This study is approved by the Human Research Ethics Committees of The Royal Children's Hospital and The Royal Women's Hospital, Melbourne. Study outcomes will be disseminated through conference presentations, peer-reviewed publications and social media. TRIAL REGISTRATION NUMBER ACTRN12619001266156.
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Affiliation(s)
- Kate L Cameron
- Victorian Infant Brain Studies, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Physiotherapy, University of Melbourne, Parkville, Victoria, Australia
| | | | - Kim Allison
- Physiotherapy, University of Melbourne, Parkville, Victoria, Australia
| | - Natalie A Fini
- Physiotherapy, University of Melbourne, Parkville, Victoria, Australia
- Physiotherapy, Alfred Health, Melbourne, Victoria, Australia
| | - Jeanie L Y Cheong
- Newborn Research, Royal Women's Hospital, Parkville, Victoria, Australia
- Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
| | - Alicia J Spittle
- Victorian Infant Brain Studies, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Physiotherapy, University of Melbourne, Parkville, Victoria, Australia
- Newborn Research, Royal Women's Hospital, Parkville, Victoria, Australia
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18
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Sanchez K, Spittle AJ, Boyce JO, Leembruggen L, Mantelos A, Mills S, Mitchell N, Neil E, John MS, Treloar J, Morgan AT. Conversational Language in 3-Year-Old Children Born Very Preterm and at Term. J Speech Lang Hear Res 2020; 63:206-215. [PMID: 31855605 PMCID: PMC7213482 DOI: 10.1044/2019_jslhr-19-00153] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 03/06/2019] [Accepted: 09/19/2019] [Indexed: 06/02/2023]
Abstract
Purpose Language difficulties are prevalent among children born preterm. Existing studies have largely used standardized language tests, providing limited scope for detailed descriptive examination of preterm language. This study aimed to examine differences in conversational language between children born < 30 weeks and at term as well as correlations between language sample analysis (LSA) and a standardized language tool. Method Two hundred four 3-year-olds (103 born < 30 weeks, 101 born at term) recruited at birth provided a 10-min language sample and completed the Preschool Language Scales-Fifth Edition (I. Zimmerman, Steiner, & Pond, 2011). LSA was conducted using the Systematic Analysis of Language Transcripts and Index of Productive Syntax. Group differences were analyzed using linear regression, and Pearson correlation coefficient (coef) was used to determine correlations between measures. Results Children born < 30 weeks scored lower than term-born peers on multiple metrics when controlled for confounding factors (sex, high social risk, multilingualism, and diagnosed neurodevelopmental disorders), including mean length of utterance in morphemes (coef = -0.28, 95% confidence interval [CI] [-0.56, 0.01]) and words (coef = -0.29, 95% CI [-0.53, -0.05]), number of different word roots (coef = -10.04, 95% CI [-17.93, -2.14]), and Index of Productive Syntax sentence structures (coef = -1.81, 95% CI [-3.10, -0.52]). Other variables (e.g., number of utterances, number of nouns and adjectives) were not significantly different between groups. LSA and the Preschool Language Scales-Fifth Edition were at most moderately correlated (≤ .45). Conclusions Three-year-old children born preterm demonstrated poorer conversational language than children born at term, with some specific areas of deficit emerging. Furthermore, formal assessment and LSA appear to provide relatively distinct and yet complementary data to guide diagnostic and intervention decisions. Supplemental Material https://doi.org/10.23641/asha.11368073.
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Affiliation(s)
- Katherine Sanchez
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Speech Pathology and Audiology, The University of Melbourne, Parkville, Victoria, Australia
| | - Alicia J. Spittle
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Physiotherapy, The University of Melbourne, Parkville, Victoria, Australia
- The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Jessica O. Boyce
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Speech Pathology and Audiology, The University of Melbourne, Parkville, Victoria, Australia
| | - Linda Leembruggen
- Department of Speech Pathology and Audiology, The University of Melbourne, Parkville, Victoria, Australia
| | - Anastasia Mantelos
- Department of Speech Pathology and Audiology, The University of Melbourne, Parkville, Victoria, Australia
| | - Stephanie Mills
- Department of Speech Pathology and Audiology, The University of Melbourne, Parkville, Victoria, Australia
| | - Naomi Mitchell
- Department of Speech Pathology and Audiology, The University of Melbourne, Parkville, Victoria, Australia
| | - Emily Neil
- Department of Speech Pathology and Audiology, The University of Melbourne, Parkville, Victoria, Australia
| | - Miya St John
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Jasmin Treloar
- Department of Speech Pathology and Audiology, The University of Melbourne, Parkville, Victoria, Australia
| | - Angela T. Morgan
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Speech Pathology and Audiology, The University of Melbourne, Parkville, Victoria, Australia
- Department of Speech Pathology, the Royal Children's Hospital, Parkville, Victoria, Australia
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19
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Chioukh FZ, Ben Ameur K, Kasdallah N, Blibech S, Ben Hamida E, Ayadi I, Ben Hamouda H, Soua H, Charfi M, Hamida N, Monastiri K, Douagi M, Marrakchi Z, Gargouri A. Extremely preterm infants in Tunisia: Where are we now? Tunis Med 2018; 96:510-513. [PMID: 30430530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Extremely preterm infants are newborns born before 28 weeks of gestation. Survival of these immature newborns depends on resuscitation and the quality of care during hospitalization. OBJECTIVE To determine survival and neurologic outcomes at2 years after extremely preterm birth. METHODS It is a retrospective multicentric study in 5 neonatal intensive care units (NICU) in 2012-2013.All live births less than 28 weeks gestation were included. RESULTS A total of 109 births were recorded. Prenatal corticosteroids were given in 47% of cases. Mean weight was 989g and mean age was 26 weeks gestation. Ninety percent of patients had respiratory distress syndrome and 67% of them needed respiratory support. Surfactant was given to 29% of newborns. The mortality rate atdischarge was 76%.The first cause of mortality was nosocomial infections. At thecorrected age of 2 years, 27% of survivors had abnormal neurologic outcome. CONCLUSION In our study, survival and neurologic outcomes ofextremely preterm infants were poor.In this high-risk population, improving perinatal care remains a challenge to improve long-term outcome in Tunisia.
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20
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Babata K, Bright HR, Allred EN, Erdei C, Kuban KCK, Joseph RM, O'Shea TM, Dammann O, Leviton A. Socioemotional dysfunctions at age 10 years in extremely preterm newborns with late-onset bacteremia. Early Hum Dev 2018; 121:1-7. [PMID: 29702395 PMCID: PMC6114932 DOI: 10.1016/j.earlhumdev.2018.04.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 04/18/2018] [Accepted: 04/18/2018] [Indexed: 12/14/2022]
Affiliation(s)
- Kikelomo Babata
- Division of Newborn Medicine, Tufts Medical Center, 800 Washington St, Boston, MA 02111, United States.
| | - H Reeve Bright
- Tufts University School of Medicine, 145 Harrison Ave, Boston, MA 02111, United States.
| | - Elizabeth N Allred
- Harvard Medical School, A-111, 25 Shattuck St, Boston, MA 02115, United States; Department of Neurology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, United States.
| | - Carmina Erdei
- Harvard Medical School, A-111, 25 Shattuck St, Boston, MA 02115, United States; Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, 25 Francis St, Boston, MA 02115, United States.
| | - Karl C K Kuban
- Department of Pediatrics, Division of Pediatric Neurology, Boston University Medical Center, 725 Albany St, 8th Floor, Suite 8C, Boston, MA 02118, United States.
| | - Robert M Joseph
- Department of Anatomy and Neurobiology, Boston University School of Medicine, 72 East Concord St (L 1004), Boston, MA 02118, United States.
| | - T Michael O'Shea
- Department of Pediatrics, University of North Carolina, 321 S Columbia St, Chapel Hill, NC 27514, United States.
| | - Olaf Dammann
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Ave, Boston, MA 02111, United States; Perinatal Neuroepidemiology Unit, OE 6415, Department of Pediatrics, Hannover Medical School, 30623 Hannover, Germany.
| | - Alan Leviton
- Harvard Medical School, A-111, 25 Shattuck St, Boston, MA 02115, United States; Department of Neurology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, United States.
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21
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Abstract
To find out why children born extremely preterm are at heightened risk of executive dysfunctions, the authors assessed 716 children who were 10 years old born extremely preterm whose IQ was ≥ 70. A working memory dysfunction (n = 169), an inhibition dysfunction (n = 360), a switching dysfunction (355), and all 3 (executive dysfunction; n = 107) were defined on the basis of Z-scores ≤ -1 on the Differential Ability Scales-II Working Memory composite, and/or on the NEPSY-II Inhibition-Inhibition and Inhibition-Switching subtests. All risk profiles include an indicator of socioeconomic disadvantage. The risk profile of each of the 3 individual dysfunctions includes an indicator of the newborn's immaturity, and the risk profiles of the inhibition dysfunction and switching dysfunction also include an indicator of inflammation. Only the switching dysfunction was associated with fetal growth restriction. The risk factors for executive dysfunction can be subsumed under the 4 themes of socioeconomic disadvantage, immaturity/vulnerability, inflammation, and fetal growth restriction.
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Affiliation(s)
- Alan Leviton
- Boston Children’s Hospital and Harvard Medical School,
Boston MA, USA
| | | | | | - T. Michael O’Shea
- University of North Carolina School of Medicine, Chapel Hill NC,
USA
| | - H. Gerry Taylor
- Nationwide Children’s Hospital and The Ohio State
University, Columbus, OH, USA
| | - Karl KC Kuban
- Boston Medical Center and Boston University School of Medicine,
Boston, MA, USA
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22
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Zimmerman E. Do Infants Born Very Premature and Who Have Very Low Birth Weight Catch Up With Their Full Term Peers in Their Language Abilities by Early School Age? J Speech Lang Hear Res 2018; 61:53-65. [PMID: 29255846 DOI: 10.1044/2017_jslhr-l-16-0150] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 08/03/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE This study examined the extent to which children born preterm (< 37 weeks) and/or who have low birth weight (< 2,500 g) catch up with their full term peers in terms of their language abilities at early school age (≥ 5 to < 9 years). METHOD A systematic literature search identified empirical studies that fit the inclusion criteria. Data from the tests/questionnaires used for meta-analysis spanned the following language categories: total language score, expressive language, receptive language, pragmatics, phonological awareness, and grammar. The means (standard deviations) were extracted from the studies and were converted to mean difference and 95% confidence intervals to test for overall effect. RESULTS Sixteen studies met the inclusionary criteria, for a total of 2,739 participants, of which 1,224 were born full term and 1,515 were born preterm. It is important to note that the preterm cohort represented very preterm infants who have a very low birth weight. The meta-analysis found that preterm infants scored significantly worse on total language (p < .001), receptive language (p < .001), expressive language (p < .001), phonological awareness (p < .001), and grammar (p = .03) than their full term peers. However, preterm infants did not score significantly worse than their peers on their pragmatics (p = .19). CONCLUSIONS Children born VPT and who have VLBW perform worse than their peers on their total language, receptive language, expressive language, phonological awareness, and grammar abilities by early school age. This information is important for speech-language pathologists to consider as children born prematurely reach school age.
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Affiliation(s)
- Emily Zimmerman
- Department of Communication Sciences and Disorders, Northeastern University, Boston, MA
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23
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Zuccarini M, Guarini A, Savini S, Iverson JM, Aureli T, Alessandroni R, Faldella G, Sansavini A. Object exploration in extremely preterm infants between 6 and 9 months and relation to cognitive and language development at 24 months. Res Dev Disabil 2017; 68:140-152. [PMID: 28779627 DOI: 10.1016/j.ridd.2017.06.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 05/03/2017] [Accepted: 06/03/2017] [Indexed: 06/07/2023]
Abstract
Although early object exploration is considered a key ability for subsequent achievements, very few studies have analyzed its development in extremely low gestational age infants (ELGA- GA <28 weeks), whose early motor skills are delayed. Moreover, no studies have examined its developmental relationship with cognitive and language skills. The present study examined developmental change in Motor Object Exploration (MOE) and different types of MOE (Holding, Oral, Manual and Manual Rhythmic Exploration) in 20 ELGA and 20 full term (FT) infants observed during mother-infant play interaction at 6 and 9 months. It also explored whether specific types of MOE were longitudinally related to 24-month language and cognitive abilities (GMDS-R scores). ELGA infants increased MOE duration from 6 to 9 months, eliminating the initial difference with FT infants. In addition, ELGA infants showed a different pattern of Oral Exploration, that did not increase at 6 months and decrease at 9 months. Oral and Manual Exploration durations at 6 months were longitudinally related to 24-month GMDS-R language and cognitive performance scores respectively. We discuss the relevance of assessing early exploratory abilities in ELGA infants in order to implement customized intervention programs for supporting the development of these skills.
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Affiliation(s)
- Mariagrazia Zuccarini
- Department of Psychology, University of Bologna, Via Berti Pichat, 5-40127 Bologna, Italy.
| | - Annalisa Guarini
- Department of Psychology, University of Bologna, Via Berti Pichat, 5-40127 Bologna, Italy.
| | - Silvia Savini
- Department of Psychology, University of Bologna, Via Berti Pichat, 5-40127 Bologna, Italy.
| | - Jana M Iverson
- Department of Psychology, University of Pittsburgh, USA.
| | - Tiziana Aureli
- Department of Neuroscience, Imaging and Clinical Sciences, University of Chieti-Pescara, Italy.
| | - Rosina Alessandroni
- Neonatology and Neonatal Intensive Care Unit - S. Orsola-Malpighi Hospital, Department of Medical and Surgical Sciences, University of Bologna, Italy.
| | - Giacomo Faldella
- Neonatology and Neonatal Intensive Care Unit - S. Orsola-Malpighi Hospital, Department of Medical and Surgical Sciences, University of Bologna, Italy.
| | - Alessandra Sansavini
- Department of Psychology, University of Bologna, Via Berti Pichat, 5-40127 Bologna, Italy.
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Scott MN, Hunter SJ, Joseph RM, OʼShea TM, Hooper SR, Allred EN, Leviton A, Kuban K. Neurocognitive Correlates of Attention-Deficit Hyperactivity Disorder Symptoms in Children Born at Extremely Low Gestational Age. J Dev Behav Pediatr 2017; 38:249-259. [PMID: 28410255 PMCID: PMC5746049 DOI: 10.1097/dbp.0000000000000436] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Compared with children born near term, those born extremely preterm (EP) are at much higher risk for attention-deficit hyperactivity disorder (ADHD). Little information is available about differences in neuropsychological outcomes among EP children with and without ADHD. Our analyses aimed to evaluate the neuropsychological correlates of ADHD symptoms in extremely low gestational age newborns (ELGANs). METHODS We obtained Child Symptom Inventory-4 reports from parents (n = 871) and teachers (n = 634) of 10-year-old children born before the 28th week of gestation. Participants completed standardized assessments of neurocognitive and academic functioning. RESULTS In the total sample, children who screened positive for ADHD symptoms were at increased risk for neurocognitive limitations. These associations were weaker when the sample was limited to those with intelligence quotient (IQ) ≥70 or ≥85. Even those with IQ ≥85 who screened positive for ADHD symptoms were more likely than their peers to have deficits on the DAS-II Working Memory Cluster and the NEPSY-II Auditory Response subtest. The risks for impaired academic performance (Z ≤ -1) on components of the WIAT-III were 2-to-3 times higher in this group than among ELGANs not classified as having ADHD symptoms. CONCLUSION Among children born EP, those with ADHD symptoms are more likely to have global neurocognitive impairment. When IQ is within normal limits, ADHD symptoms are associated with deficits in executive functioning skills. These findings highlight a group at risk for executive functioning deficits and related academic difficulties, even in the absence of intellectual disability.
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Affiliation(s)
- Megan N Scott
- *Department of Psychiatry and Behavioral Neuroscience, The University of Chicago Medicine, Chicago, IL; †Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA; ‡Division of Neonatology, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC; §Department of Allied Health Sciences, University of North Carolina School of Medicine, Chapel Hill, NC; Departments of ‖Neurology and ¶Neurology Research, Boston Children's Hospital and Harvard Medical School, Boston MA; **Division of Pediatric Neurology, Boston Medical Center, Boston University School of Medicine, Boston, MA
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Mathewson KJ, Chow CHT, Dobson KG, Pope EI, Schmidt LA, Van Lieshout RJ. Mental health of extremely low birth weight survivors: A systematic review and meta-analysis. Psychol Bull 2017. [PMID: 28191983 DOI: 10.1037/bu10000091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Although individuals born at extremely low birth weight (ELBW; < 1,000 g) are the most vulnerable of all preterm survivors, their risk for mental health problems across the life span has not been systematically reviewed. The primary objective of this systematic review and meta-analysis was to ascertain whether the risk for mental health problems is greater for ELBW survivors than their normal birth weight (NBW) peers in childhood, adolescence, and adulthood. Forty-one studies assessing 2,712 ELBW children, adolescents, and adults and 11,127 NBW controls were reviewed. Group differences in mental health outcomes were assessed using random effects meta-analyses. The impacts of birthplace, birth era, and neurosensory impairment on mental health outcomes were assessed in subgroup analyses. Children born at ELBW were reported by parents and teachers to be at significantly greater risk than NBW controls for inattention and hyperactivity, internalizing, and externalizing symptoms. ELBW children were also at greater risk for conduct and oppositional disorders, autistic symptoms, and social difficulties. Risks for parent-reported inattention and hyperactivity, internalizing, and social problems were greater in adolescents born at ELBW. In contrast, ELBW teens self-reported lower inattention, hyperactivity, and oppositional behavior levels than their NBW peers. Depression, anxiety, and social difficulties were elevated in ELBW survivors in adulthood. Group differences were robust to region of birth, era of birth, and the presence of neurosensory impairments. The complex needs faced by children born at ELBW continue throughout development, with long-term consequences for psychological and social well-being. (PsycINFO Database Record
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Affiliation(s)
- Karen J Mathewson
- Department of Psychology, Neuroscience and Behavior, McMaster University
| | | | - Kathleen G Dobson
- Department of Clinical Epidemiology and Biostatistics, McMaster University
| | - Eliza I Pope
- Department of Psychology, Neuroscience and Behavior, McMaster University
| | - Louis A Schmidt
- Department of Psychology, Neuroscience and Behavior, McMaster University
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26
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Treyvaud K, Aldana AC, Scratch SE, Ure AM, Pace CC, Doyle LW, Anderson PJ. The influence of multiple birth and bereavement on maternal and family outcomes 2 and 7years after very preterm birth. Early Hum Dev 2016; 100:1-5. [PMID: 27399608 DOI: 10.1016/j.earlhumdev.2016.04.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 04/21/2016] [Accepted: 04/21/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Psychological distress has been reported by mothers of infants born very preterm (VPT) and by mothers of multiples (twins and triplets). This study examined the influence of i) multiple birth and ii) bereavement associated with a multifetal pregnancy, on mental health, parenting stress and family functioning for mothers of children born VPT across early childhood. METHODS Participants were 162 mothers of 194 infants (129 singletons, 65 multiples) born at <30weeks' gestation or with a birth weight<1250g who completed questionnaires when their children were two and seven years corrected age. Fifteen mothers (9%) experienced bereavement associated with a multifetal pregnancy. Maternal mental health was assessed using the General Health Questionnaire at two years and Hospital Anxiety and Depression Scale at seven years. Parenting stress and family functioning were assessed using the Parenting Stress Index and Family Assessment Device. RESULTS Maternal mental health, stress and family functioning were similar in mothers of VPT singletons and multiples. However compared with mothers who had not experienced bereavement, mothers who had were 3.6 times [95% confidence interval (95% CI) 1.05, 12.5] more likely to report elevated anxiety symptoms and 3.6 times [95% CI 1.05, 12.3] more likely to report elevated depressive symptoms when their VPT child was seven years old. CONCLUSIONS The results of this study highlight the need for monitoring and offering ongoing support to bereaved mothers with surviving VPT children. However, within the context of VPT birth, multiple birth does not increase the risk for maternal psychological distress in early childhood.
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Affiliation(s)
- Karli Treyvaud
- LaTrobe University, Victoria, Australia; Murdoch Childrens Research Institute, Victoria, Australia; University of Melbourne, Victoria, Australia; Royal Women's Hospital, Victoria, Australia.
| | | | | | | | - Carmen C Pace
- Murdoch Childrens Research Institute, Victoria, Australia
| | - Lex W Doyle
- Murdoch Childrens Research Institute, Victoria, Australia; University of Melbourne, Victoria, Australia
| | - Peter J Anderson
- Murdoch Childrens Research Institute, Victoria, Australia; University of Melbourne, Victoria, Australia
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Benassi E, Savini S, Iverson JM, Guarini A, Caselli MC, Alessandroni R, Faldella G, Sansavini A. Early communicative behaviors and their relationship to motor skills in extremely preterm infants. Res Dev Disabil 2016; 48:132-144. [PMID: 26555385 DOI: 10.1016/j.ridd.2015.10.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 10/18/2015] [Accepted: 10/19/2015] [Indexed: 06/05/2023]
Abstract
Despite the predictive value of early spontaneous communication for identifying risk for later language concerns, very little research has focused on these behaviors in extremely low-gestational-age infants (ELGA<28 weeks) or on their relationship with motor development. In this study, communicative behaviors (gestures, vocal utterances and their coordination) were evaluated during mother-infant play interactions in 20 ELGA infants and 20 full-term infants (FT) at 12 months (corrected age for ELGA infants). Relationships between gestures and motor skills, evaluated using the Bayley-III Scales were also examined. ELGA infants, compared with FT infants, showed less advanced communicative, motor, and cognitive skills. Giving and representational gestures were produced at a lower rate by ELGA infants. In addition, pointing gestures and words were produced by a lower percentage of ELGA infants. Significant positive correlations between gestures (pointing and representational gestures) and fine motor skills were found in the ELGA group. We discuss the relevance of examining spontaneous communicative behaviors and motor skills as potential indices of early development that may be useful for clinical assessment and intervention with ELGA infants.
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Affiliation(s)
- Erika Benassi
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Silvia Savini
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Jana M Iverson
- Department of Psychology, University of Pittsburgh, Pittsburgh, USA
| | | | - Maria Cristina Caselli
- Institute of Cognitive Sciences and Technologies, National Research Council, Rome, Italy
| | - Rosina Alessandroni
- Neonatology and Neonatal Intensive Care Unit, S. Orsola-Malpighi Hospital, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Giacomo Faldella
- Neonatology and Neonatal Intensive Care Unit, S. Orsola-Malpighi Hospital, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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28
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Scratch SE, Anderson PJ, Doyle LW, Thompson DK, Ahmadzai ZM, Greaves RF, Inder TE, Hunt RW. High Postnatal Growth Hormone Levels Are Related to Cognitive Deficits in a Group of Children Born Very Preterm. J Clin Endocrinol Metab 2015; 100:2709-17. [PMID: 25974734 PMCID: PMC4490305 DOI: 10.1210/jc.2014-4342] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 05/08/2015] [Indexed: 11/19/2022]
Abstract
CONTEXT AND OBJECTIVES Little is known regarding the influence of GH on brain development, especially in infants born very preterm (VP; <30 weeks' gestation). Preterm infants are thought to have higher levels of GH in the first days of life compared with full-term infants. VP infants experience cognitive difficulties in childhood and have a diffuse pattern of structural brain abnormalities. This study aimed to explore the relationship between postnatal GH concentrations following VP birth and its association with cognitive functioning and brain volumes at age 7 years. METHODS Eighty-three infants born VP had GH concentrations measured at eight time points postnatally, and 2- and 6-week area under the curve (AUC) summary measures were calculated. Followup at age 7 years included neuropsychological assessment and brain magnetic resonance imaging. Univariable and multivariable regression modeling were used where AUC for GH was the main predictor of neurodevelopmental outcome at age 7 years. RESULTS Univariable modeling revealed that higher GH levels (2-week AUC) were related to poorer performance on a verbal working memory (P = .04) and shifting attention task (P = .01). These relationships persisted on multivariable modeling and when the 6-week AUC was analyzed; working memory (P = .03), immediate spatial memory (P = .02), and delayed spatial memory (P = .03) deficits were found. Higher GH levels were also associated with larger amygdala volumes after adjustment for potential confounders (P = .002, 2-week AUC; P = .03, 6-week AUC). CONCLUSIONS Higher postnatal GH levels may potentially contribute to the documented neurodevelopmental abnormalities seen in children born VP at school age.
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Affiliation(s)
- Shannon E Scratch
- Clinical Sciences (S.E.S., P.J.A., L.W.D., D.K.T., Z.M.A., R.F.G., T.E.I., R.W.H.), Murdoch Childrens Research Institute, Royal Children's Hospital, Victoria, 3052 Australia; Faculty of Medicine, Dentistry and Health Sciences (S.E.S., P.J.A., L.W.D., D.K.T., R.W.H.), The University of Melbourne, Victoria, 3010 Australia; The Royal Women's Hospital (L.W.D.), Victoria, 3052 Australia; School of Medical Sciences (R.F.G.), RMIT University, Victoria, 3000 Australia; Department of Pediatric Newborn Medicine (T.E.I.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115; and The Royal Children's Hospital (R.W.H.), Melbourne, 3052 Australia
| | - Peter J Anderson
- Clinical Sciences (S.E.S., P.J.A., L.W.D., D.K.T., Z.M.A., R.F.G., T.E.I., R.W.H.), Murdoch Childrens Research Institute, Royal Children's Hospital, Victoria, 3052 Australia; Faculty of Medicine, Dentistry and Health Sciences (S.E.S., P.J.A., L.W.D., D.K.T., R.W.H.), The University of Melbourne, Victoria, 3010 Australia; The Royal Women's Hospital (L.W.D.), Victoria, 3052 Australia; School of Medical Sciences (R.F.G.), RMIT University, Victoria, 3000 Australia; Department of Pediatric Newborn Medicine (T.E.I.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115; and The Royal Children's Hospital (R.W.H.), Melbourne, 3052 Australia
| | - Lex W Doyle
- Clinical Sciences (S.E.S., P.J.A., L.W.D., D.K.T., Z.M.A., R.F.G., T.E.I., R.W.H.), Murdoch Childrens Research Institute, Royal Children's Hospital, Victoria, 3052 Australia; Faculty of Medicine, Dentistry and Health Sciences (S.E.S., P.J.A., L.W.D., D.K.T., R.W.H.), The University of Melbourne, Victoria, 3010 Australia; The Royal Women's Hospital (L.W.D.), Victoria, 3052 Australia; School of Medical Sciences (R.F.G.), RMIT University, Victoria, 3000 Australia; Department of Pediatric Newborn Medicine (T.E.I.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115; and The Royal Children's Hospital (R.W.H.), Melbourne, 3052 Australia
| | - Deanne K Thompson
- Clinical Sciences (S.E.S., P.J.A., L.W.D., D.K.T., Z.M.A., R.F.G., T.E.I., R.W.H.), Murdoch Childrens Research Institute, Royal Children's Hospital, Victoria, 3052 Australia; Faculty of Medicine, Dentistry and Health Sciences (S.E.S., P.J.A., L.W.D., D.K.T., R.W.H.), The University of Melbourne, Victoria, 3010 Australia; The Royal Women's Hospital (L.W.D.), Victoria, 3052 Australia; School of Medical Sciences (R.F.G.), RMIT University, Victoria, 3000 Australia; Department of Pediatric Newborn Medicine (T.E.I.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115; and The Royal Children's Hospital (R.W.H.), Melbourne, 3052 Australia
| | - Zohra M Ahmadzai
- Clinical Sciences (S.E.S., P.J.A., L.W.D., D.K.T., Z.M.A., R.F.G., T.E.I., R.W.H.), Murdoch Childrens Research Institute, Royal Children's Hospital, Victoria, 3052 Australia; Faculty of Medicine, Dentistry and Health Sciences (S.E.S., P.J.A., L.W.D., D.K.T., R.W.H.), The University of Melbourne, Victoria, 3010 Australia; The Royal Women's Hospital (L.W.D.), Victoria, 3052 Australia; School of Medical Sciences (R.F.G.), RMIT University, Victoria, 3000 Australia; Department of Pediatric Newborn Medicine (T.E.I.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115; and The Royal Children's Hospital (R.W.H.), Melbourne, 3052 Australia
| | - Ronda F Greaves
- Clinical Sciences (S.E.S., P.J.A., L.W.D., D.K.T., Z.M.A., R.F.G., T.E.I., R.W.H.), Murdoch Childrens Research Institute, Royal Children's Hospital, Victoria, 3052 Australia; Faculty of Medicine, Dentistry and Health Sciences (S.E.S., P.J.A., L.W.D., D.K.T., R.W.H.), The University of Melbourne, Victoria, 3010 Australia; The Royal Women's Hospital (L.W.D.), Victoria, 3052 Australia; School of Medical Sciences (R.F.G.), RMIT University, Victoria, 3000 Australia; Department of Pediatric Newborn Medicine (T.E.I.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115; and The Royal Children's Hospital (R.W.H.), Melbourne, 3052 Australia
| | - Terrie E Inder
- Clinical Sciences (S.E.S., P.J.A., L.W.D., D.K.T., Z.M.A., R.F.G., T.E.I., R.W.H.), Murdoch Childrens Research Institute, Royal Children's Hospital, Victoria, 3052 Australia; Faculty of Medicine, Dentistry and Health Sciences (S.E.S., P.J.A., L.W.D., D.K.T., R.W.H.), The University of Melbourne, Victoria, 3010 Australia; The Royal Women's Hospital (L.W.D.), Victoria, 3052 Australia; School of Medical Sciences (R.F.G.), RMIT University, Victoria, 3000 Australia; Department of Pediatric Newborn Medicine (T.E.I.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115; and The Royal Children's Hospital (R.W.H.), Melbourne, 3052 Australia
| | - Rodney W Hunt
- Clinical Sciences (S.E.S., P.J.A., L.W.D., D.K.T., Z.M.A., R.F.G., T.E.I., R.W.H.), Murdoch Childrens Research Institute, Royal Children's Hospital, Victoria, 3052 Australia; Faculty of Medicine, Dentistry and Health Sciences (S.E.S., P.J.A., L.W.D., D.K.T., R.W.H.), The University of Melbourne, Victoria, 3010 Australia; The Royal Women's Hospital (L.W.D.), Victoria, 3052 Australia; School of Medical Sciences (R.F.G.), RMIT University, Victoria, 3000 Australia; Department of Pediatric Newborn Medicine (T.E.I.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115; and The Royal Children's Hospital (R.W.H.), Melbourne, 3052 Australia
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Serenius F, Källén K, Blennow M, Ewald U, Fellman V, Holmström G, Lindberg E, Lundqvist P, Maršál K, Norman M, Olhager E, Stigson L, Stjernqvist K, Vollmer B, Strömberg B. Neurodevelopmental outcome in extremely preterm infants at 2.5 years after active perinatal care in Sweden. JAMA 2013; 309:1810-20. [PMID: 23632725 DOI: 10.1001/jama.2013.3786] [Citation(s) in RCA: 365] [Impact Index Per Article: 33.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Active perinatal care increases survival of extremely preterm infants; however, improved survival might be associated with increased disability among survivors. OBJECTIVE To determine neurodevelopmental outcome in extremely preterm children at 2.5 years (corrected age). DESIGN, SETTING, AND PARTICIPANTS Population-based prospective cohort of consecutive extremely preterm infants born before 27 weeks of gestation in Sweden between 2004 and 2007. Of 707 live-born infants, 491 (69%) survived to 2.5 years. Survivors were assessed and compared with singleton control infants who were born at term and matched by sex, ethnicity, and municipality. Assessments ended in February 2010 and comparison estimates were adjusted for demographic differences. MAIN OUTCOMES AND MEASURES Cognitive, language, and motor development was assessed with Bayley Scales of Infant and Toddler Development (3rd edition; Bayley-lll), which are standardized to mean (SD) scores of 100 (15). Clinical examination and parental questionnaires were used for diagnosis of cerebral palsy and visual and hearing impairments. Assessments were made by week of gestational age. RESULTS At a median age of 30.5 months (corrected), 456 of 491 (94%) extremely preterm children were evaluated (41 by chart review only). For controls, 701 had information on health status and 366 had Bayley-lll assessments. Mean (SD) composite Bayley-III scores (cognition, 94 [12.3]; language, 98 [16.5]; motor, 94 [15.9]) were lower than the corresponding mean scores for controls (cognition, 104 [10.6]; P < .001; adjusted difference in mean scores, 9.2 [99% CI, 6.9-11.5]; language, 109 [12.3]; P < .001; adjusted difference in mean scores, 9.3 [99% Cl, 6.4-12.3]; and motor, 107 [13.7]; P < .001; adjusted difference in mean scores, 12.6 [99% Cl, 9.5-15.6]). Cognitive disability was moderate in 5% of the extremely preterm group vs 0.3% in controls (P < .001) and it was severe in 6.3% of the extremely preterm group vs 0.3% in controls (P < .001). Language disability was moderate in 9.4% of the extremely preterm group vs 2.5% in controls (P < .001) and severe in 6.6% of the extremely preterm group vs 0% in controls (P < .001). Other comparisons between the extremely preterm group vs controls were for cerebral palsy (7.0% vs 0.1%; P < .001), for blindness (0.9% vs 0%; P = .02), and for hearing impairment (moderate and severe, 0.9% vs 0%; P = .02, respectively). Overall, 42% (99% CI, 36%-48%) of extremely preterm children had no disability, 31% (99% CI, 25%-36%) had mild disability, 16% (99% CI, 12%-21%) had moderate disability, and 11% (99% CI, 7.2%-15%) had severe disability. Moderate or severe overall disability decreased with gestational age at birth (22 weeks, 60%; 23 weeks, 51%; 24 weeks, 34%; 25 weeks, 27%; and 26 weeks, 17%; P for trend < .001). CONCLUSIONS AND RELEVANCE Of children born extremely preterm and receiving active perinatal care, 73% had mild or no disability and neurodevelopmental outcome improved with each week of gestational age. These results are relevant for clinicians counseling families facing extremely preterm birth.
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Affiliation(s)
- Fredrik Serenius
- Department of Women's and Children's Health, Section for Pediatrics, Uppsala University, S-751 85 Uppsala, Sweden.
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Ritter BC, Nelle M, Perrig W, Steinlin M, Everts R. Executive functions of children born very preterm--deficit or delay? Eur J Pediatr 2013; 172:473-83. [PMID: 23247616 DOI: 10.1007/s00431-012-1906-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Revised: 11/28/2012] [Accepted: 11/28/2012] [Indexed: 11/30/2022]
Abstract
UNLABELLED This cross-sectional study examined the performance of children born very preterm and/or at very low birth weight (VPT/VLBW) and same-aged term-born controls in three core executive functions: inhibition, working memory, and shifting. Children were divided into two age groups according to the median (young, 8.00-9.86 years; old, 9.87-12.99 years). The aims of the study were to investigate whether (a) VPT/VLBW children of both age groups performed poorer than controls (deficit hypothesis) or caught up with increasing age (delay hypothesis) and (b) whether VPT/VLBW children displayed a similar pattern of performance increase in executive functions with advancing age compared with the controls. Fifty-six VPT/VLBW children born in the cohort of 1998-2003 and 41 healthy-term-born controls were recruited. All children completed tests of inhibition (Color-Word Interference Task, Delis-Kaplan Executive Function System (D-KEFS)), working memory (Digit Span Backwards, HAWIK-IV), and shifting (Trail Making Test, Number-Letter Sequencing, D-KEFS). Results revealed that young VPT/VLBW children performed significantly poorer than the young controls in inhibition, working memory, and shifting, whereas old VPT/VLBW children performed similar to the old controls across all three executive functions. Furthermore, the frequencies of impairment in inhibition, working memory and shifting were higher in the young VPT/VLBW group compared with the young control group, whereas frequencies of impairment were equal in the old groups. In both VPT/VLBW children and controls, the highest increase in executive performance across the ages of 8 to 12 years was observed in shifting, followed by working memory, and inhibition. CONCLUSIONS This study provides evidence that (a) poor performance in inhibition, working memory, and shifting of young VPT/VLBW children might reflect a delay rather than a deficit and (b) that VPT/VLBW children are likely to display a similar pattern of performance increase in these three executive functions compared with that of controls.
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Affiliation(s)
- Barbara Catherine Ritter
- Division of Neuropaediatrics, Development and Rehabilitation, Children's University Hospital, Inselspital, 3010 Bern, Switzerland.
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O'Shea TM, Shah B, Allred EN, Fichorova RN, Kuban KCK, Dammann O, Leviton A. Inflammation-initiating illnesses, inflammation-related proteins, and cognitive impairment in extremely preterm infants. Brain Behav Immun 2013; 29:104-112. [PMID: 23295265 PMCID: PMC3582030 DOI: 10.1016/j.bbi.2012.12.012] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 12/17/2012] [Accepted: 12/19/2012] [Indexed: 12/11/2022] Open
Abstract
Neonatal inflammation is associated with perinatal brain damage. We evaluated to what extent elevated blood levels of inflammation-related proteins supplement information about the risk of impaired early cognitive function provided by inflammation-related illnesses. From 800 infants born before the 28th week of gestation, we collected blood spots on days 1, 7 and 14, for analysis of 25 inflammation-related proteins, and data about culture-positive bacteremia, necrotizing enterocolitis (Bell stage IIIb), and isolated perforation of the intestine, during the first two weeks, and whether they were ventilated on postnatal day 14. We considered a protein to be persistently or recurrently elevated if its concentration was in the top quartile (for gestational age and day blood was collected) on two separate days one week apart. We assessed the children at 2 years of age with the Bayley Mental Development Index (MDI). The combinations of NEC and ventilation on day 14, and of bacteremia and ventilation on day 14 consistently provided information about elevated risk of MDI <55, regardless of whether or not a variable for an elevated protein concentration was included in the model. A variable for a persistently or recurrently elevated concentration of each of the following proteins provided additional information about an increased risk of MDI <55: CRP, SAA, IL-6, TNF-alpha, IL-8, MIP-1beta, ICAM-1, E-SEL, and IGFBP-1. We conclude that elevated blood concentrations of inflammation-related proteins provide information about the risk of impaired cognitive function at age 2 years that supplements information provided by inflammation-associated illnesses.
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Affiliation(s)
- T Michael O'Shea
- Division of Neonatology, Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.
| | - Bhavesh Shah
- Department of Pediatrics, Baystate Children's Hospital, Springfield, MA 01199, USA
| | - Elizabeth N Allred
- Department of Neurology, Children's Hospital Boston, and Harvard Medical School, Boston, MA 02115, USA
| | - Raina N Fichorova
- Laboratory of Genital Tract Biology, Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Karl C K Kuban
- Division of Pediatric Neurology, Department of Pediatrics, Boston University, Boston, MA 02118, USA
| | - Olaf Dammann
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA 02111, USA; Perinatal Epidemiology Unit, Hannover Medical School, 30623 Hannover, Germany
| | - Alan Leviton
- Department of Neurology, Children's Hospital Boston, and Harvard Medical School, Boston, MA 02115, USA
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Aarnoudse-Moens CSH, Weisglas-Kuperus N, Duivenvoorden HJ, van Goudoever JB, Oosterlaan J. Executive function and IQ predict mathematical and attention problems in very preterm children. PLoS One 2013; 8:e55994. [PMID: 23390558 PMCID: PMC3563540 DOI: 10.1371/journal.pone.0055994] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Accepted: 01/03/2013] [Indexed: 11/19/2022] Open
Abstract
Objective of this study was to examine the impact of executive function (EF) on mathematical and attention problems in very preterm (gestational age ≤ 30 weeks) children. Participants were 200 very preterm (mean age 8.2 ± 2.5 years) and 230 term children (mean age 8.3 ± 2.3 years) without severe disabilities, born between 1996 and 2004. EFs assessed included verbal fluency, verbal working memory, visuospatial span, planning, and impulse control. Mathematics was assessed with the Dutch Pupil Monitoring System and parents and teachers rated attention problems using standardized behavior questionnaires. The impact of EF was calculated over and above processing speed indices and IQ. Interactions with group (very preterm versus term birth status) were examined. Analyses were conducted separately for two subsamples: children in preschool and children in primary school. Very preterm children performed poorer on tests for mathematics and had more parent and teacher rated attention problems than term controls (ß(s)>.11, P(s)<.01). IQ contributed unique variance to mathematics in preschool and in primary school (ß(s)>.16, P(s)<.007). A significant interaction of group with IQ (ß = -. 24, P = .02) showed that IQ contributed unique variance to attention problems as rated by teachers, but that effects were stronger for very preterm than for term infants. Over and above IQ, EF contributed unique variance to mathematics in primary school (ß = .13, P<.001), to parent rated inattention in preschool and in primary school (ß(s)>-.16, P(s)<.04), and to teacher rated inattention in primary school (ß = -.19; ß = .19, P(s)<.009). In conclusion, impaired EF is, over and above impaired IQ, an important predictor for poor mathematics and attention problems following very preterm birth.
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Abstract
This commentary is on the original article by Potharst et al. on pages 178–184 of this issue
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Affiliation(s)
- Neil Marlow
- UCL EGA Institute for Women's Health, University College London, London, UK
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Roscigno CI, Savage TA, Kavanaugh K, Moro TT, Kilpatrick SJ, Strassner HT, Grobman WA, Kimura RE. Divergent views of hope influencing communications between parents and hospital providers. Qual Health Res 2012; 22:1232-1246. [PMID: 22745363 PMCID: PMC3572714 DOI: 10.1177/1049732312449210] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
This study evaluated parents' and health care providers' (HCPs) descriptions of hope following counseling of parents at risk of delivering an extremely premature infant. Data came from a longitudinal multiple case study investigation that examined the decision making and support needs of 40 families and their providers. Semistructured interviews were conducted before and after delivery. Divergent viewpoints of hope were found between parents and many HCPs and were subsequently coded using content analysis. Parents relied on hope as an emotional motivator, whereas most HCPs described parents' notions of hope as out of touch with reality. Parents perceived that such divergent beliefs about the role of hope negatively shaped communicative interactions and reduced trust with some of their providers. A deeper understanding of how varying views of hope might shape communications will uncover future research questions and lead to theory-based interventions aimed at improving the process of discussing difficult news with parents.
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Affiliation(s)
- Cecelia I Roscigno
- University of North Carolina School of Nursing, Chapel Hill, North Carolina 27599-7460, USA.
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