Preterm birth and adult wealth: mathematics skills count

Each year, 15 million babies are born preterm worldwide. Preterm birth is associated with adverse neurodevelopmental outcomes across the lifespan. Recent registry-based studies suggest that preterm birth is associated with lower wealth in adulthood, but the mediating mechanisms are unknown. This study investigated whether the relationship between preterm birth and low adult wealth is mediated by poor academic abilities and educational qualifications. Participants were members of two British population-based birth cohorts born in 1958 and 1970. Results showed that preterm birth was associated with decreased wealth at 42 years of age. This association was mediated by poorer intelligence, reading and, in particular, mathematics attainment in middle childhood, and lower educational qualifications in young adulthood. Findings were similar in both cohorts, suggesting that these mechanisms may be time invariant. Special educational support in childhood may prevent preterm children from becoming less wealthy as adults

Universal gestational age effects on cognitive and basic mathematic processing

Prematurity has adverse effects on basic mathematic processing following birth at all gestations <36 weeks and on IQ and mathematic attainment <34 weeks GA. The ability to predict IQ and mathematic processing scores from one cohort to another among children cared for in different eras and countries indicates that universal neurodevelopmental factors explain the effects of gestation at birth. In contrast, mathematic attainment may be improved by schooling

Learning disabilities among extremely preterm children without neurosensory impairment: Comorbidity, neuropsychological profiles and scholastic outcomes

Background: Children born extremely preterm are at high risk for intellectual impairment, learning disabilities, executive dysfunction and special educational needs, but little is understood about the comorbidity of intellectual and learning disorders in this population. Aims: This study explored comorbidity in intellectual disability (ID) and learning disabilities (LD) in children born extremely preterm (EP; <26+0 weeks’ gestation). Subjects and study design: A UK national cohort of 161 EP children and 153 term-born controls without neurosensory impairments was assessed at 11 years of age (the EPICure Study). Outcome measures: IQ, mathematics and reading attainment, executive function, visuospatial processing and sensorimotor skills were assessed using standardised tests, and curriculum-based attainment and special educational needs (SEN) using teacher reports. Results: Overall, 75 (47%) EP children and 7 (4.6%) controls had ID or LD (RR 10.12; 95% CI 4.81, 21.27). Comorbidity in ID/LD was more common among EP children than controls (24% vs. 0%). EP children with comorbid ID/LD had significantly poorer neuropsychological abilities and curriculum-based attainment than EP children with isolated or no disabilities. LD were associated with a 3 times increased risk for SEN. However, EP children with ID alone had poorer neuropsychological abilities and curriculum-based attainment than children with no disabilities, yet there was no increase in SEN provision among this group. Conclusions: EP children are at high risk for comorbid intellectual and learning disabilities. Education professionals should be aware of the complex nature of EP children’s difficulties and the need for multi-domain assessments to guide intervention

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

Objective: To compare health-related quality of life (HRQL) in childhood for extremely preterm (EP) births before 26 weeks of gestation in England in two eras: 1995 and 2006.Design: Prospective cohort studies.Setting: School or home-based assessments at 11 years of age.Participants: Available data for 88 EP children born before 26 weeks of gestation in 2006 (EPICure2) were compared with those of 140 born in England during 1995 (EPICure). To account for social secular trends, the comparison between eras was also made for term-born controls as reference.Main outcome measures: HRQL was measured using the parent-completed Health Utilities Index (HUI) questionnaire with utility scores calculated using the HUI3 classification system. Eight attributes were assessed: vision, hearing, speech, ambulation, dexterity, emotion, cognition and pain.Results: At 11 years, mean utility scores were significantly lower in EPICure2 (2006) than in EPICure (1995; Δ -0.12, 95% CI -0.20 to -0.04). The difference increased (Δ -0.27, 95% CI -0.41 to -0.12) after adjusting for significant perinatal and demographic differences between cohorts. Rates of suboptimal function were increased in EPICure2 for all eight attributes, but statistically significant differences were only found in speech (p=0.004) and dexterity (p=0.020). After excluding children with severe neurodevelopmental impairment, the adjusted difference between cohorts remained significant but attenuated (-0.14 (-0.26 to -0.01)). Mean utility scores for controls were similar between cohorts (Δ -0.01 (-0.04 to 0.02)).Conclusions: Using parent report, there was a clinically significant decline in HRQL ratings for EP children over time. Areas contributing the most to the decline were speech and dexterity.</div

Is preterm birth overlooked in child and adolescent psychiatry?

Obstetric factors have long been recognised as risk factors for the later development of poor mental health. One of the most consistently reported of these associations is for preterm birth (birth before 37 weeks’ gestation), a form of early adversity that impacts health and development across the life course. Preterm birth is not uncommon: in 2014, 10.6% of live births globally (nearly 15 million babies) were preterm.1 Advances in neonatal care since the early 1990s have dramatically increased the numbers of babies who survive extremely preterm birth (birth at < 28 weeks’ gestation) in high-income countries. This has led to growing interest in how extremely preterm birth impacts longer term outcomes including psychosocial development across the life-span

Additional file 1: of Does psychological functioning mediate the relationship between bullying involvement and weight loss preoccupation in adolescents? A two-stage cross-sectional study

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Neuropsychological Outcomes at 19 Years of Age following Extremely Preterm Birth

BACKGROUND & OBJECTIVES: Children born extremely preterm (METHODS: 127 young adults born extremely preterm and 64 term-born controls had a neuropsychological assessment at 19 years of age examining general cognitive abilities (IQ), visuo-motor abilities, prospective memory and aspects of executive functions and language.RESULTS: Adults born extremely preterm scored significantly lower than term-born controls across all neuropsychological tests with effect sizes (Cohen’s d) of 0.7-1.2. Sixty percent of adults born extremely preterm had impairment in at least one neuropsychological domain; deficits in general cognitive functioning and visuo-motor abilities were most frequent. The proportion of extremely preterm participants with an intellectual impairment (IQCONCLUSIONS: Adults born extremely preterm continue to perform lower than their term-born peers in general cognitive abilities as well as across a range of neuropsychological functions, indicating that these young adults do not show improvement overtime. The prevalence of intellectual impairment increased from 11 years into adulthood.</div

Health-related quality of life from adolescence to adulthood following extremely preterm birth

ObjectiveTo examine self-reported and parent-reported health-related quality of life (HRQL) in adults born extremely preterm compared with control participants born at term and to evaluate trajectories of health status from adolescence to early adulthood.Study designThe EPICure study comprises all births ResultsParticipants born extremely preterm without neurodevelopmental impairment had significantly lower MAU scores at 19 years than controls (median [IQR]: 0.91 [0.79, 0.97] vs 0.97 [0.87, 1.00], P = .008); those with impairment had the lowest scores (0.74 [0.49, 0.90]). A 0.03-0.05 difference is considered clinically significant. Parent-reported findings were similar. Participants born extremely preterm with impairment rated their health significantly better than their parents did (0.74 vs 0.58, P = .01), in contrast to those without impairment and controls. Between 11 and 19 years, median parent-reported MAU scores decreased from 0.87 to 0.77 for participants born extremely preterm (P = .01) and from 1.00 to 0.97 for control participants (P = .02).ConclusionsAmong young adults born extremely preterm, both participants and parents rated their health status less favorably than control participants born at term. The decline in MAU scores from adolescence to early adulthood following extremely preterm birth indicates continuing health issues in young adult life.</div

Extremely Preterm Birth and Autistic Traits in Young Adulthood: The EPICure Study

BackgroundA high prevalence of autism spectrum disorder is reported in children born extremely preterm (EP), but an even larger proportion of survivors are affected by subclinical difficulties than meet diagnostic criteria. The aims of this study were to investigate autistic traits associated with the broader autism phenotype in a cohort of young adults born EP, and explore how these traits relate to emotion recognition, empathy and autism symptom presentation in childhood. The prevalence of autism diagnoses was also investigated.MethodsOne hundred and twenty-nine young adults born before 26 weeks of gestation and 65 term-born controls participated in the 19-year follow-up phase of the EPICure studies. In addition to a clinical interview, participants completed the Broader Autism Phenotype Questionnaire (BAPQ), the Empathy Quotient questionnaire, and the Frankfurt Test and Training of Facial Affect Recognition. The Social Communication Questionnaire (SCQ) was completed by the participants’ parents at age 11 years.ResultsEP born young adults scored significantly higher on the BAPQ in comparison with their term-born peers, indicating greater autistic traits. Among EP participants, BAPQ scores were correlated with SCQ scores in childhood (r = 0.484, p LimitationsThe high attrition of EP participants from lower socio-economic backgrounds and with lower cognitive functioning may have led to an underrepresentation of those presenting with difficulties associated with autism.ConclusionsA larger proportion of EP survivors are affected by difficulties associated with autism than have confirmed diagnoses, with a moderate correlation between autism symptom scores in childhood and autistic traits in young adulthood. EP young adults had significantly higher autism symptom scores and a larger proportion had a diagnosis of autism than controls. Screening for autistic traits at set points throughout childhood will help identify those EP individuals at risk of social difficulties who may benefit from intervention.</div

Comparing Behavioural Outcomes in Children Born Extremely Preterm between 2006 and 1995: The EPICure Studies

  Background Children born extremely preterm (EP) are at increased risk of neurocognitive and behavioural morbidity. Here, we investigate whether behavioural outcomes have changed over time concomitant with increasing survival following EP birth. Methods Comparison of outcomes at 11 years of age for two prospective national cohorts of children born EP in 1995 (EPICure) and 2006 (EPICure2), assessed alongside term-born children. Behavioural outcomes were assessed using the parent-completed Strengths and Difficulties Questionnaire (SDQ), DuPaul Attention-Deficit/Hyperactivity Disorder Rating Scale (ADHD-RS), and Social Communication Questionnaire (SCQ). Results In EPICure, 176 EP and 153 term-born children were assessed (mean age: 10.9 years); in EPICure2, 112 EP and 143 term-born children were assessed (mean age: 11.8 years). In both cohorts, EP children had higher mean scores and more clinically significant difficulties than term-born children on almost all measures. Comparing outcomes for EP children in the two cohorts, there were no significant differences in mean scores or in the proportion of children with clinically significant difficulties after adjustment for confounders. Using term-born children as reference, EP children in EPICure2 had significantly higher SDQ total difficulties and ADHD-RS hyperactivity impulsivity z-scores than EP children in EPICure. Conclusions Behavioural outcomes have not improved for EP children born in 2006 compared with those born in 1995. Relative to term-born peers, EP children born in 2006 had worse outcomes than those born in 1995. There is an ongoing need for long-term clinical follow-up and psychological support for children born EP.</p