Long-term survival quality of former very low birth weight infants

Background: Premature birth is associated with an increased risk for the development of cognitive, learning and psychological problems in childhood. It is uncertain which problems remain, which decrease and which problems may newly arise in the transition from childhood into adulthood. Objective: The following question should be answered: how do those infants born very preterm (VP <32 weeks gestation) or of very low birth weight (VLBW <1500 g) master the transition into adulthood compared to full term infants? Material and methods: The Bavarian longitudinal study is a geographically defined study of VP and VLBW infants born in 1985 and 1986. Out of 411 VP and VLBW survivors that still lived in Germany 260 (63 %) were reassessed at 26 years of age together with 229 out of 308 full term born infants (74 %) from the same period. Most participants had taken part in all seven follow-up visits throughout childhood. The major findings are reviewed in the context of results from other cohort and register studies around the world. Results: Most of the difficulties identified in childhood (e.g. multiple cognitive problems, anxiety, withdrawn personality and social problems) remained into adulthood. These have adverse effects on economic independence and the quality of life. Conclusion: It is crucial to carry out long-term investigations of older and new cohorts up into adulthood to answer the question whether improved obstetric and neonatal care has not only led to improved survival but also to improved quality of survival

Effects of gestational age and early parenting on children’s social inhibition at 6 years

Preterm birth (<37 weeks’ gestation) has been associated with problems in social functioning. Whether social inhibition is specifically related to preterm birth and whether early parenting may protect against social inhibition difficulties is unknown. To explore effects of gestational age and early parent–infant relationships on social inhibition, 1314 children born at 26–41 weeks gestational age were studied as part of the prospective Bavarian Longitudinal Study. Early parent–infant relationship quality was assessed postnatally with the parent–infant relationship index. Social inhibition was assessed at age 6 years using an experimental procedure, in which nonverbal and verbal responses were coded into social inhibition categories (disinhibited, normally responsive, inhibited). Multinomial logistic regressions indicated that children with lower gestational age showed more socially disinhibited (nonverbal: OR = 1.27 [95% CI = 1.17–1.40], verbal: OR = 1.23 [95% CI 1.13–1.35]) and inhibited (nonverbal: OR = 1.21 [95% CI = 1.11–1.32], verbal: OR = 1.11 [95% CI = 1.01–1.21]) responses. Good early parent–infant relationships were associated with less verbal disinhibition (OR = 0.70 [95% CI = 0.52–0.93]). Findings suggest that children with lower gestational age are at greater risk to be both socially inhibited and disinhibited. Early parenting affected risk of abnormal social responses. Supporting early parent–infant relationships may reduce preterm children’s risk for social difficulties. View Full-Tex

Origins and predictors of friendships in 6- to 8-year-old children born at neonatal risk

Objective To test effects of gestational age (GA), early social experiences, and child characteristics on children's friendships and perceived peer acceptance. Study design As part of the prospective Bavarian Longitudinal Study (1147 children, 25-41 weeks GA), children's friendships (eg, number of friends, frequency of meeting friends) and perceived peer acceptance were assessed before school entry (6 years of age) and in second grade (8 years of age) using child and parent reports. The parent–infant relationship was evaluated during the 5 months after birth. Child characteristics (ie, height, motor impairment, cognitive ability, behavioral problems) were measured at 6 years of age. Multiple regressions estimated effects of GA, parent–infant relationship, and child characteristics. Results Overall, children with higher GA had more friends, spent more time with friends, and were more accepted by peers at 6 years of age. Better parent–infant relationships, higher cognitive abilities, and fewer motor and behavioral problems predicted more friendships and higher peer acceptance after adjusting for sex, socioeconomic status, multiples, siblings, and special schooling. Across all GA groups, number of friends (child report: mean change, 1.77; 95% CI, 1.57-1.96) and peer acceptance (child report: mean change, 0.14; 95% CI, 0.09-0.19; parent report: mean change, 0.14; 95% CI, 0.11-0.17) increased with age, but the increase in number of friends was higher among preterm children (ie, interaction effect age*GA group: P = .034). Conclusions Our results provide evidence of a dose–response effect of low GA on children's friendships and perceived peer acceptance. Improvements in early parenting and motor, cognitive, and behavioral development may facilitate friendships and peer acceptance for all children across the gestation spectrum

Effects of Gestational Age and Early Parenting on Children’s Social Inhibition at 6 Years

Preterm birth (\u3c37 weeks’ gestation) has been associated with problems in social functioning. Whether social inhibition is specifically related to preterm birth and whether early parenting may protect against social inhibition difficulties is unknown. To explore effects of gestational age and early parent–infant relationships on social inhibition, 1314 children born at 26–41 weeks gestational age were studied as part of the prospective Bavarian Longitudinal Study. Early parent–infant relationship quality was assessed postnatally with the parent–infant relationship index. Social inhibition was assessed at age 6 years using an experimental procedure, in which nonverbal and verbal responses were coded into social inhibition categories (disinhibited, normally responsive, inhibited). Multinomial logistic regressions indicated that children with lower gestational age showed more socially disinhibited (nonverbal: OR = 1.27 [95% CI = 1.17–1.40], verbal: OR = 1.23 [95% CI 1.13–1.35]) and inhibited (nonverbal: OR = 1.21 [95% CI = 1.11–1.32], verbal: OR = 1.11 [95% CI = 1.01–1.21]) responses. Good early parent–infant relationships were associated with less verbal disinhibition (OR = 0.70 [95% CI = 0.52–0.93]). Findings suggest that children with lower gestational age are at greater risk to be both socially inhibited and disinhibited. Early parenting affected risk of abnormal social responses. Supporting early parent–infant relationships may reduce preterm children’s risk for social difficulties

General cognitive but not mathematic abilities predict very preterm and healthy term born adults’ wealth

Objective Very preterm (<32 weeks gestation; VP) and/or very low birth weight (<1500g; VLBW) children often have cognitive and mathematic difficulties. It is unknown whether VP/VLBW children’s frequent mathematic problems significantly add to the burden of negative life-course consequences over and above effects of more general cognitive deficits. Our aim was to determine whether negative consequences of VP/VLBW versus healthy term birth on adult wealth are mediated by mathematic abilities in childhood, or rather explained by more general cognitive abilities. Methods 193 VP/VLBW and 217 healthy term comparison participants were studied prospectively from birth to adulthood as part of a geographically defined study in Bavaria (South Germany). Mathematic and general cognitive abilities were assessed at 8 years with standardized tests; wealth information was assessed at 26 years with a structured interview and summarized into a comprehensive index score. All scores were z-standardized. Results At 8 years, VP/VLBW (n = 193, 52.3% male) had lower mathematic and general cognitive abilities than healthy term comparison children (n = 217, 47.0% male). At 26 years, VP/VLBW had accumulated significantly lower overall wealth than term born comparison adults (-0.57 (1.08) versus -0.01 (1.00), mean difference 0.56 [0.36–0.77], p < .001). Structural equation modeling confirmed that VP/VLBW birth (β = -.13, p = .022) and childhood IQ (β = .24, p < .001) both directly predicted adult wealth, but math did not (β = .05, p = .413). Analyses were controlled for small-for-gestational-age (SGA) birth, child sex, and family socioeconomic status. Conclusion This longitudinal study from birth to adulthood shows that VP/VLBW survivors’ general cognitive rather than specific mathematic problems explain their diminished life-course success. These findings are important in order to design effective interventions at school age that reduce the burden of prematurity for those individuals who were born at highest neonatal risk

Effects of maternal sensitivity on low birth weight children's academic achievement : a test of differential susceptibility versus diathesis stress

Background: Differential Susceptibility Theory (DST) postulates that some children are more affected – for better and for worse – by developmental experiences, including parenting, than others. Low birth weight (LBW, 1,500–2,499 g) may not only be a predictor for neurodevelopmental impairment but also a marker for prenatally programmed susceptibility. The aim was to test if effects of sensitive parenting on LBW and very LBW (VLBW, <1,500 g) versus normal birth weight (NBW, ≥2,500 g) children's academic achievement are best explained by a differential susceptibility versus diathesis-stress model of person-X-environment interaction. Methods: Nine hundred and twenty-two children ranging from 600 g to 5,140 g birth weight were studied as part of a prospective, geographically defined, longitudinal investigation of neonatal at-risk children in South Germany (Bavarian Longitudinal Study). Sensitive parenting during a structured mother–child interaction task was observed and rated at age 6 years. Academic achievement was assessed with standardized mathematic, reading, and spelling/writing tests at age 8 years. Results: Maternal sensitivity positively predicted the academic achievement of both LBW (n = 283) and VLBW (n = 202) children. Confirmatory-comparative and model-fitting analysis (testing LBW vs. NBW and VLBW vs. NBW) indicated that LBW and VLBW children were more susceptible than NBW to the adverse effects of low-sensitive, but not beneficial effects of high-sensitive parenting. Conclusions: Findings proved more consistent with the diathesis stress than differential-susceptibility model of person-X-environment interaction: LBW and VLBW children's exposure to positive parenting predicted catch-up to their NBW peers, whereas exposure to negative parenting predicted much poorer functioning

General cognitive but not mathematic abilities predict very preterm and healthy term born adults’ wealth

Objective Very preterm (\u3c32 weeks gestation; VP) and/or very low birth weight (\u3c1500g; VLBW) children often have cognitive and mathematic difficulties. It is unknown whether VP/VLBW children’s frequent mathematic problems significantly add to the burden of negative life-course consequences over and above effects of more general cognitive deficits. Our aim was to determine whether negative consequences of VP/VLBW versus healthy term birth on adult wealth are mediated by mathematic abilities in childhood, or rather explained by more general cognitive abilities. Methods 193 VP/VLBW and 217 healthy term comparison participants were studied prospectively from birth to adulthood as part of a geographically defined study in Bavaria (South Germany). Mathematic and general cognitive abilities were assessed at 8 years with standardized tests; wealth information was assessed at 26 years with a structured interview and summarized into a comprehensive index score. All scores were z-standardized. Results At 8 years, VP/VLBW (n = 193, 52.3% male) had lower mathematic and general cognitive abilities than healthy term comparison children (n = 217, 47.0% male). At 26 years, VP/VLBW had accumulated significantly lower overall wealth than term born comparison adults (-0.57 (1.08) versus -0.01 (1.00), mean difference 0.56 [0.36–0.77], p \u3c .001). Structural equation modeling confirmed that VP/VLBW birth (β = -.13, p = .022) and childhood IQ (β = .24, p \u3c .001) both directly predicted adult wealth, but math did not (β = .05, p = .413). Analyses were controlled for small-for-gestational-age (SGA) birth, child sex, and family socioeconomic status. Conclusion This longitudinal study from birth to adulthood shows that VP/VLBW survivors’ general cognitive rather than specific mathematic problems explain their diminished life-course success. These findings are important in order to design effective interventions at school age that reduce the burden of prematurity for those individuals who were born at highest neonatal risk

Head growth and intelligence from birth to adulthood in very preterm and term born individuals

Objectives: The aim of this study was to investigate the effects of infant and toddler head growth on intelligence scores from early childhood to adulthood in very preterm (<32 weeks gestational age; VP) and/or very low birth weight (<1500 g; VLBW) and term born individuals. Methods: 203 VP/VLBW and 198 term comparisons were studied from birth to adulthood as part of the prospective geographically defined Bavarian Longitudinal Study (BLS). Head circumference was assessed at birth; 5, 20 months; and 4 years of age. Intelligence was assessed with standardized tests in childhood (6 and 8 years: K-ABC) and at 26 years (Wechsler Adult Intelligence Scale, WAIS). Structural equation modeling (SEM) was used to model the effect of head growth on IQ. Results: On average, VP/VLBW had lower head circumference at birth (27.61 cm vs. 35.11 cm, mean difference 7.49, 95% confidence interval [7.09–7.90]) and lower adult intelligence scores (88.98 vs. 102.54, mean difference 13.56 [10.59–16.53]) than term born comparison individuals. Head circumference at birth (e.g., total effect β=.48; p<.001 for adult IQ) and head growth in childhood predicted intelligence development from age 6 to 26 years in both VP/VLBW and term born individuals (70% of variance in adult IQ explained by full model). Effects of gestation and birth weight on intelligence were fully mediated by head circumference and growth. Conclusions: This longitudinal investigation from birth to adulthood indicates head growth as a proxy of brain development and intelligence. Repeated early head circumference assessment adds valuable information when screening for long-term neurocognitive risk. (JINS, 2019, 25, 48#x2013;56

Neonatal predictors of cognitive ability in adults born very preterm : a prospective cohort study

Aim: To identify neonatal predictors to allow a developmental prognosis of the cognitive abilities of survivors born very preterm/very low birthweight (VLBW) into adult life. Method: The Bavarian Longitudinal Study is a prospective whole-population study that followed 260 infants born very preterm/VLBW from birth to adulthood. Regression analyses examined which neonatal factors predicted adult IQ. Results: Neonatal morbidity, neonatal treatment, and early social environment of infants born very preterm/VLBW explained 37.6% of the variance in adult IQ. Seven unique early-life predictors of lower adulthood IQ were found: respiratory distress syndrome, intraventricular haemorrhage, problems with mobility, mechanical ventilation, less parenteral nutrition, low/middle socioeconomic status, and poor early parent–infant relationships. Specifically, modifiable factors such as mechanical ventilation predicted a drop of 0.43 IQ points for each day of treatment, adjusted for initial respiratory problems. Good early parent–infant relationships predicted an approximately 5-point increase in adult IQ, adjusted for other significant predictors such as socioeconomic status. Interpretation: Mechanical ventilation, parenteral feeding, and early parenting were identified as significant modifiable factors that were strongly related to adult IQ. Mechanical ventilation policies have changed but there is scope for early interventions that focus on positive parenting, which may reduce the adverse effects of very preterm/VLBW birth on cognitive abilities

Attention problems in very preterm children from childhood to adulthood : the Bavarian longitudinal study

Background: Very preterm (VP; gestational age <32 weeks) and very low birth weight (VLBW; <1500 grams) is related to attention problems in childhood and adulthood. The stability of these problems into adulthood is not known. Methods: The Bavarian Longitudinal Study is a prospective cohort study that followed 260 VP/VLBW and 229 term-born individuals from birth to adulthood. Data on attention were collected at 6, 8, and 26 years of age, using parent reports, expert behavior observations, and clinical ADHD diagnoses. Results: At each assessment, VP/VLBW individuals had significantly more attention problems, shorter attention span, and were more frequently diagnosed with ADHD than term-born comparisons. In both VP/VLBW and term-born individuals, overall, attention span increased and attention problems decreased from childhood to adulthood. Attention problems and attention span were more stable over time for VP/VLBW than term-born individuals. Similarly, ADHD diagnoses showed moderate stability from childhood to adulthood in VP/VLBW, but not in term-born individuals. However, when those with severe disabilities were excluded, differences between VP/VLBW and term-born individuals reduced. Conclusions: Despite improvement in attention regulation from childhood to adulthood, children born very preterm remained at increased risk for attention problems in adulthood. In contrast, term-born children with clinical attention problems outgrew these by adulthood. As inattentive behavior of VP/VLBW children may be overlooked by teachers, it may be necessary to raise awareness for school intervention programs that reduce attention problems in VP/VLBW children