Biological and Environmental Predictors of Behavioral Sequelae in Children Born Preterm

Abstract

OBJECTIVE By using behavioral outcome measures of children who were born preterm, we evaluated differences between children who were born at term and children who were born at extremely low (ELBW; <1000 g) and very low birth weights (VLBW; 1000 –1499 g) and assessed the relationship of birth weight, socioeconomic status, and cognitive ability to behavioral outcome. METHODS We studied a total of 104 children (aged 7–16 years). Of these, 49 had a preterm birth (31 of ELBW and 18 of VLBW). The remaining 55 were healthy control subjects. Children were administered tests of cognitive ability. Parents and teachers completed behavioral assessments. Multivariate analyses of covariance assessed differences between children who were born at term and those who were born of ELBW and of VLBW on behavioral measures. Hierarchical linear regressions were used to assess relationships among biological (birth weight), environmental (socioeconomic status), intellectual, and behavioral variables. RESULTS Children who were born at term had fewer parent reports of hyperactivity/inattention and depression/anxiety symptoms than children of ELBW and VLBW. Teacher ratings were not significant between groups. Birth weight was consistently the strongest predictor of parent ratings of behavioral outcome, and intelligence level did not seem to mediate this relationship. CONCLUSIONS Negative behavioral sequelae of preterm birth remain significant in middle childhood and adolescence, although the contribution of multiple factors to neurobehavioral outcome is complex. Research to assess these relationships, integrated with anatomic and functional neuroimaging, is needed to advance knowledge and improve outcomes for children who are born preterm.

Indicators of problems evaluated by parents and children stratified by birth weight

“…These results are in agreement with those of other studies available in the literature, which reported greater vulnerability of low birth weight children exposed to risk factors of behavioral problems, especially hyperactivity (Pettersson et al, 2014;Scott et al, 2012;Singh et al, 2013) and childhood depression (Conrad et al, 2010;Hayes & Sharif, 2009;Lieshout & Boylan, 2010).…”

“…Studies on the negative effects of low birth weight and their association with environmental risk factors have confirmed the correlation between biological risk factors and social adversities (Bohnert & Breslau, 2008;Conrad et al, 2010;Saur, 2012;Vanderbilt & Gleason, 2010).…”

“…However, with regard to the potential implications of low birth weight in the behavioral and emotional development of children, several studies are based solely on reports by parents (Espírito Santo, Portuguez, & Nunes, 2009;Gallo et al, 2011;Pettersson et al, 2014;Singh et al, 2013) or reports by parents and teachers (Conrad et al, 2010;Scott et al, 2012), without including children's self-report.…”

Comportamento de Escolares Estratificados pelo Peso ao Nascer e Idade Gestacional

“…E, no estudo de Hack et al (2004), o resultado mais positivo pode estar relacionado com a idade de avaliação, já que os problemas comportamentais tendem a diminuir com a idade (Wiles et al, 2006). Quanto à escala de hiperatividade, as crianças do grupo MBP apresentaram significativamente mais dificuldades em comparação aos outros grupos de peso, o que é concordante com estudos prévios que relatam que as crianças nascidas com muito baixo peso apresentam mais dificuldades nessa área em comparação às crianças nascidas com peso normal (Conrad et al, 2009;Hack et al, 2004;Msall & Park, 2008). Por outro lado, no grupo PIG não foi observada mais dificuldade nessa escala, o que coloca em destaque uma peculiaridade desse grupo, e a relevância da comparação de critérios de estratificação com a mesma amostra.…”

“…Alguns estudos mostram que crianças nascidas com baixo peso apresentam mais problemas comportamentais em comparação às crianças nascidas com peso normal (Aarnoudse-Moens, Weisglas-Kuperus, Goudoever, & van Osterlaan, 2009;Bhutta, Cleves, Casey, Cradock, & Anand, 2002;Conrad, Richman, Lindgren, & Nopoulos, 2009;Gallo et al, 2011;Hack et al, 2004;Martins, Linhares, & Martinez, 2005;Oliveira, Enumo, Queiroz, & Azevedo Jr, 2011;Reijneveld et al, 2006;Rodrigues, Mello, & Fonseca, 2006;Wiles et al, 2006). Em estudo conduzido por Gallo et al (2011), por exemplo, foi avaliada uma coorte de 4.357 crianças, aos 11 anos, por meio do Questionário de Capacidades e Dificuldades (do inglês Strengths and Difficulties Questionnaire -SDQ), com o objetivo de verificar a associação entre o tamanho ao nascimento e SKB Correia et al problemas de saúde mental.…”