Higher rates of behavioural and emotional problems at preschool age in children born moderately preterm

Objective To compare preschool children born moderately preterm (MP; 32-35 weeks' gestation) and children born at term (38-41 weeks' gestation) regarding the occurrence of behavioural and emotional problems, overall, for separate types of problems and by gender. Design Prospective cohort study consisting of a community-based sample of MP and a random sample of term-born children in 13 Preventive Child Healthcare centres throughout the Netherlands. Patients 995 MP and 577 term-born children just under age 4 were included. Main outcome measures Behavioural and emotional problems were measured using the Child Behavior Checklist 1.5-5 years. Seven syndrome scales, internalising, externalising and total problems were determined. Higher scores indicate worse outcomes. Results MP children had higher scores on all syndrome scales, internalising, externalising and total problems than term-born controls. The mean difference on total problems was 4.04 (95% CI 2.08 to 6.00). Prevalence rates of elevated externalising problem scores were highest in boys (10.5%) and internalising problems were highest in girls (9.9%). MP children were at greater risk for somatic complaints (OR 1.92, 95% CI 1.09 to 3.38), internalising (OR 2.40, 95% CI 1.48 to 3.87), externalising (OR 1.69, 95% CI 1.07 to 2.67) and total problems (OR 1.84, 95% CI 1.12 to 3.00). Conclusions Moderate preterm birth affects all domains of behavioural and emotional problems, particularly for girls. MP children should be targeted for the prevention of mental health problems as they have a great impact on developmental and social competencies at school and in the community

Risk of developmental delay increases exponentially as gestational age of preterm infants decreases:a cohort study at age 4 years

Aim The aim of the study was to assess the influence of decreasing gestational age on the risk of developmental delay in various domains at age 4 years among children born at a wide range of gestational ages. Method In a community-based cohort, the parents of 1439 preterm-born children (24 0/7 to 35 6/7wks) and 544 term-born children (38 0/7 to 41 6/7wks) born in 2002 and 2003 completed the Ages and Stages Questionnaire (ASQ) when their child was 3 years 7 months to 4 years 1 month old. The prevalence rates of abnormal scores on the ASQ-total problems scale were compared in preterm and term-born children and the resulting odds ratios for gestational age groups were calculated and adjusted for social and biological covariates. Results The prevalence rates of abnormal scores on the ASQ-total problems scale increased with decreasing gestational age: from 4.2% among term-born children to 37.5% among children born at 2425 weeks gestation (p Interpretation The risk of developmental delay increases exponentially with decreasing gestational age below 36 weeks gestation on all developmental domains of the ASQ. Adjustment for covariates did not alter the pattern of exponential increase in developmental risk with decreasing gestational age. We speculate that both direct perinatal cerebral injuries and tropic and maturational brain disturbances are involved

Growth in Small-for-Gestational-Age Preterm-Born Children from 0 to 4 Years:The Role of both Prematurity and SGA Status

<p>Background: Fullterm small-for-gestational-age children (SGAs) are known for their ability to catch up on growth. Nevertheless, increased risk of growth restriction remains. Evidence on preterm SGA children's growth is lacking. Objective: To determine absolute gains in height and weight, relative growth, and growth restriction in preterm SGAs from 0 to 4 years and how prematurity and SGA status affect these measures. Design/ Methods: Community-based cohort study, n = 1,648 preterm-born (gestational age <36 weeks, 57 SGA) and 605 term-born (12 SGA). We defined SGA as a birth weight less than -2 SD (P 2.3) compared to counterparts matched for gestational age. Height, weight, and head circumference were obtained from medical records and translated to z -scores. We defined growth restriction as height or weight less than -2 SD compared to fullterm appropriate-for-gestational-age children (AGAs). Results: Absolute height and weight gains were similar, but the relative growth of preterms and fullterms differed. Preterm AGAs and fullterm SGAs, although not reaching it, caught up towards the fullterm AGA median (z -scores at 4 years: -0.3 to -1.0). By contrast, preterm SGA children's z -scores were still -1.4 to -1.7. Head circumference growth was less affected by prematurity and SGA birth (z -scores at 1 year: 0.1 to -0.7). Catch-up growth mainly took place during infancy. 30-39% of all preterm SGAs showed growth restriction at 4 years. Conclusions: Growth in preterm SGAs is affected considerably by the joint effects of preterm birth and SGA status, resulting in a high proportion of growth restriction. Copyright (C) 2013 S. Karger AG, Basel</p>

Growth of Preterm and Full-Term Children Aged 0-4 Years:Integrating Median Growth and Variability in Growth Charts

Objectives To assess the distribution of height, weight, and head circumference (HC) in preterm infants for ages 0-4 years, by gestational age (GA) and sex, and to construct growth reference charts for preterm-born children, again by GA and sex, for monitoring growth in clinical practice. Study design The community-based cohort study covered a quarter of The Netherlands. 1690 preterm infants (GA, 25-35(+6) weeks) and a random sample of 634 full-term control infants (GA 38-41(+6)), who were followed from birth to 4 years of age. Height, weight, and HC were regularly assessed during routine well-child visits and data were retrospectively collected. Results At all ages, the median height and weight of preterm children were lower compared with full-term children. Growth depended on the child's GA. Increase in HC showed an early catch-up and was similar to full-term children by the age of 1. Height, weight, and HC were more variable in boys, particularly in the very preterm children. Conclusions At 0 to 4 years, the growth of preterm children differed from that of full-term children and depended on their GA. The greater variability of growth in boys suggests that they are more vulnerable to the complications of preterm birth that influence growth. These growth charts are the most precise tools currently available for monitoring growth in preterm children. (J Pediatr 2012;161:460-5)

Developmental Delay in Moderately Preterm-Born Children at School Entry

Objective To determine the prevalence and nature of developmental delay at preschool age in infants born moderately preterm compared with those born full-term and early preterm. Study design Parents of 927 moderate preterm infants (32-35+6 weeks gestation), 512 early preterm infants (<32 weeks gestation) and 544 full-term infants (38-41+6 weeks gestation) completed the Ages and Stages Questionnaire (ASQ) when the child was aged 43-49 months. We analyzed rates of abnormal ASQ scores and odds ratios for abnormal ASQ scores in both preterm groups compared with the full-term group. We repeated the analyses after adjustment for socioeconomic status, sex, being part of a multiple birth, and small for gestational age status. Results Abnormal (ie, >2 SDs below the mean) ASQ total scores were noted in 8.3% of moderate preterm infants, in 4.2% of full-term infants, and in 14.9% of early preterm infants. ORs of abnormal ASQ total scores were 2.1 (95% CI, 1.3-3.4) for moderate preterm infants and 4.0 (95% CI, 2.4-6.5) for early preterm infants. Both moderate and early preterm infants had more frequent problems with fine motor, communication, and personal-social functioning compared with full-term infants. Compared with full-term infants, moderate preterm infants did not have a greater prevalence of problems with gross motor functioning and problem solving, whereas early preterms did. Socioeconomic status, small for gestational age status, and sex were associated with abnormal ASQ scores in moderate preterm infants. Conclusions At preschool age, the prevalence of developmental delay in moderate preterm infants was 2-fold of that in full-term infants and one-half of that in early preterm infants

Stability of Developmental Problems after School Entry of Moderately-Late Preterm and Early Preterm-Born Children

OBJECTIVE: To assess the stability of developmental problems in moderately-late preterm-born children compared with early preterm and full term-born children before school entry at age 4 years and 1 year after school entry at age 5 years. STUDY DESIGN: We included 376 early preterm, 688 born moderately-late preterm, and 403 full term-born children from the Longitudinal Preterm Outcome Project (LOLLIPOP) cohort study. Developmental problems were assessed by the total score and the 5 domain scores of the Ages and Stages Questionnaire at ages 4 (ASQ-4) and 5 (ASQ-5). From the combinations of normal and abnormal ASQ-4 and ASQ-5 scores we constructed 4 categories: consistently normal, emerging, resolving, and persistent problems. RESULTS: The ASQ-4 total score was abnormal more frequently in moderately-late preterm (7.9%, P = .016) and early preterm-born children (13.0%, P < .001) than in full term-born children (4.1%). Compared with the ASQ-5 total score, moderately-late preterm-born children had persistence and change comparable with full term-born children, and early preterm-born children had significantly greater rates than full term-born children of persistent (8.4% vs 2.2%, P < .001) and emerging problems (7.8% vs 2.7% P = .001). On the underlying domains, both early preterm and moderately-late preterm-born children had mainly emerging motor problems and resolving communication problems, but the changing rates of moderately-late preterm-born children were lower. CONCLUSIONS: After school entry, the overall development of moderately-late preterm-born children had stability patterns comparable with full term-born children, whereas early preterm-born children had greater rates of persistent and emerging problems. On the underlying domains, moderately-late preterm-born children had patterns comparable with early preterm-born children but at lower rates

Co-occurrence of developmental and behavioural problems in moderate to late preterm-born children

Objective To determine the occurrence of emotional and behavioural problems (EBP) in moderate to late preterm (MLP) and full-term children with developmental delay. Design Participants were recruited from 13 randomly selected preventive child healthcare (PCH) centres in the Netherlands. We included 903 MLP children of 3236 weeks' gestation and 538 full-term controls, born between January 2002 and June 2003. Parents completed the Ages and Stages Questionnaire (ASQ) and Child Behaviour Checklist (CBCL) shortly before the scheduled PCH visit at 4 years of age. Co-occurrence was defined as: ASQ total or domain score >2 SDs below the mean and a CBCL score > 84th percentile on total problems, internalising (emotional) or externalising (behavioural) problems. Results EBP were more prevalent among MLP children with abnormal ASQ total problems scores than among full-term children, particularly regarding externalising problems (33.8% vs 23.8%). In MLP children, rates of EBP differed per developmental domain and were highest for the domains problem-solving (36.0% had externalising problems, 95% CI 24.1% to 49.9%) and personal-social skills (38.7% had internalising problems, 95% CI 26.4% to 52.8%). The risk of any type of co-occurrence was higher for MLP than for full-term children (OR 1.86; 95% CI 1.14 to 3.03). Independent risk factors for co-occurrence were male gender, low socioeconomic status and young maternal age. Conclusions Up to 39% of 4-year-old MLP children with developmental delay also have EBP, indicating that increased awareness of EBP is warranted in MLP children with developmental delay. Further research is needed to determine whether early detection of co-occurring problems results in better long-term health

Validity and internal consistency of the Ages and Stages Questionnaire 60-month version and the effect of three scoring methods

<p>Background: The Ages and Stages Questionnaire (ASQ) is currently the most used parent-completed developmental screener consisting of different age-specific questionnaires. Psychometric evaluation of the ASQ 60-month version (ASQ-60) is limited. Furthermore, it is unclear which of the available scoring methods of the ASQ is most useful in the identification of children with potential developmental problems.</p><p>Aim: To evaluate the internal consistency and construct validity of the ASQ-60 with a large sample size, and to assess the effects of three scoring-methods on this validity.</p><p>Study design: Parents of 394 term-born and 1063 preterm-born children from the prospective cohort-study Lollipop completed the ASQ-60 and a general questionnaire on school-problems.</p><p>Outcome measures: Internal consistency and construct validity of the ASQ-60 were determined using the ASQ total score. Construct validity was also determined using two other types of scoring-methods based on low domain-scores ('ASQ domain score') and parental concerns ('ASQ total score with parental concerns').</p><p>Results: Cronbach's alpha for total score was 0.86, confirming internal consistency. Male gender, prematurity, low paternal education, low family income and small-for-gestational-age were associated with low 'ASQ total scores,' confirming construct validity. Regarding construct validity with special education as criterion, sensitivity was best using the 'ASQ domain score' or the 'ASQ total score' with parental concerns (both 0.96). However, the specificity was best (0.93) using the ASQ total score.</p><p>Conclusion: The ASQ-60 has a good internal consistency and validity to screen for developmental problems in the general population. The 'ASQ total score' has the best performance, the 'ASQ domain score' is recommended in case of preferred high sensitivity. (C) 2013 Elsevier Ireland Ltd. All rights reserved.</p>

Developmental Delay in Moderately Preterm-Born Children with Low Socioeconomic Status:Risks Multiply

Objective To assess separate and joint effects of low socioeconomic status (SES) and moderate prematurity on preschool developmental delay.Study design Prospective cohort study with a community-based sample of preterm-and term-born children (Longitudinal Preterm Outcome Project). We assessed SES on the basis of education, occupation, and family income. The Ages and Stages Questionnaire was used to assess developmental delay at age 4 years. We determined scores for overall development, and domains fine motor, gross motor, communication, problem-solving, and personal-social of 926 moderately preterm-born (MP) (32-36 weeks gestation) and 544 term-born children. In multivariable logistic regression analyses, we used standardized values for SES and gestational age (GA).Results Prevalence rates for overall developmental delay were 12.5%, 7.8%, and 5.6% in MP children with low, intermediate, and high SES, respectively, and 7.2%, 4.0%, and 2.8% in term-born children, respectively. The risk for overall developmental delay increased more with decreasing SES than with decreasing GA, but the difference was not statistically significant: OR (95% CI) for a 1 standard deviation decrease were: 1.62 (1.30-2.03) and 1.34 (1.05-1.69), respectively, after adjustment for sex, number of siblings, and maternal age. No interaction was found except for communication, showing that effects of SES and GA are mostly multiplicative.Conclusions Low SES and moderate prematurity are separate risk factors with multiplicative effects on developmental delay. The double jeopardy of MP children with low SES needs special attention in pediatric care.</p

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

BACKGROUND AND OBJECTIVES: Preterm children, compared with term children, are at increased risk of emotional and behavioral problems (EB-problems). Prevalences of EB-problems seem to vary with degree of prematurity and age at assessment. We therefore assessed individual stability of EB-problems in preterm compared with term children first before school entry and again 1 year after school entry, and variation in stability within the preterm group. METHODS: We used data of 401 early preterm (25-31 weeks' gestational age), 653 moderately preterm (32-35 weeks' gestational age), and 389 term children from the Longitudinal Preterm Outcome Project cohort study. We classified EB-problems based on the Child Behavior Checklist at ages 4 and 5; this resulted in 4 categories: consistently normal (2 normal scores), emerging (normal score at age 4 and clinical/subclinical score at age 5), resolving, and persistent EB-problems. RESULTS: All preterm children had higher rates than term children of persistent (7.2% vs 3.6%), emerging (4.3% vs 2.3%), and resolving (7.5% vs 3.6%) EB-problems. Early preterm children had the highest rates of persistent (8.2%) and emerging (5.2%) problems, and moderately preterm children had the highest rates of resolving problems (8.7%). In both preterm and term children, predictive values of normal scores at age 4 for normal scores at age 5 were similar to 96%, and of clinical/subclinical scores at age 4 for clinical/subclinical scores at age 5 were similar to 50%, except for early preterm children (60%). CONCLUSIONS: Compared with term children, all preterm children are at risk for persistent and changing EB-problems at school entry; individual stability, however, is difficult to predict based solely on the factor of preterm-birth