Exceeding expectations after perinatal risks for poor development: associations in term- and preterm-born preschoolers

Neel, Mary Lauren; Silva, Aryanne de; Taylor, H. Gerry; Benninger, Kristen; Busch, Tyler; Hone, Emily; Moore‐Clingenpeel, Melissa; Pietruszewski, Lindsay; Maitre, Nathalie L.

doi:10.1038/s41372-021-01254-9

Cited by 6 publications

(7 citation statements)

References 56 publications

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“…Children and adolescents born preterm are at significantly increased risk for psychiatric disorders compared to their full‐term peers (Burnett et al, 2011; Fitzallen et al, 2020; Pyhälä et al, 2017). Children born preterm were 1.5 times more likely to be diagnosed with anxiety, and for those with anxiety there was a four‐fold increased risk of Attention Deficit Hyperactivity Disorder and a five‐fold increased risk of conduct disorders compared to the term control group, supporting the association between anxiety and behavioral problems (Neel et al, 2021). A meta‐analysis of psychiatric diagnoses in individuals born preterm (ages 10–25), identified 3.8 fold increased risk of any psychiatric diagnosis and a three‐fold increased risk of anxiety (a component of internalizing behaviors) compared to term born participants (Burnett et al, 2011).…”

Section: Introductionmentioning

confidence: 89%

“…The proximal environment consists of daily parent-child interactions characteristics and qualities, family attitudes and beliefs; the distal environment encompasses societal and socioeconomic factors (Winchester et al, 2018). Supportive childhood environments have long been associated with better neurodevelopmental outcomes and have been used as an explanation for "better than expected" outcomes (Neel et al, 2021).…”

Section: Environmental Contextmentioning

confidence: 99%

“…The proximal environment consists of daily parent‐child interactions characteristics and qualities, family attitudes and beliefs; the distal environment encompasses societal and socioeconomic factors (Winchester et al, 2018). Supportive childhood environments have long been associated with better neurodevelopmental outcomes and have been used as an explanation for “better than expected” outcomes (Neel et al, 2021). Developmental‐ecological frameworks assert that individual behaviors are the result of the interplay between the child, family, and social context (Bronfenbrenner & Evans, 2000; Bronfenbrenner & Morris, 2006).…”

Section: Introductionmentioning

confidence: 99%

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A test of differential susceptibility in behavior trajectories of preterm infants from preschool to adulthood

Kelly

Arcoleo

D'Agata

et al. 2022

Research in Nursing & Health

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Preterm birth predisposes children to internalizing and externalizing behaviors that may persist into adolescence resulting in adult mental health conditions. Social and caregiving contexts, particularly for vulnerable infants born preterm, influence longterm outcomes, but mechanisms are not clearly understood. Healthcare teams caring for those born preterm face difficulty predicting who will be most affected by risk, who will most benefit, and the optimal timing of intervention. Differential susceptibility theory offers an alternative to the traditional risk-only assessments and theories by positing that individuals may be more, or less, susceptible to environmental influences.A sample of preterm-and term-born infants were followed from birth to 23 years of age. Mixed model repeated measures analyses of internalizing and externalizing behaviors were utilized for the comparison groups (N = 214; observations = 1070).Environmental contexts were indexed as proximal protection (low, moderate, high) and medical risk (low, moderate, high). Personal characteristic covariates of sex, race, socioeconomic status, and cognition were modeled. Internalizing behavior trajectories varied significantly over time. Early proximal protective environments conferred a sustained positive influence on behaviors. There is partial support for differential susceptibility theory suggesting that prematurity, as a malleability characteristic enables absorption of both the positive and negative influences of the environment, with greater intensity that those without malleability. The current analyses suggest lasting effects of the preschool age proximal environment on internalizing and externalizing behaviors in young adulthood for those born preterm. Understanding these nuances may aid healthcare professionals in the promotion and timing of interventions to support the child and family. The current manuscript reflects ongoing analyses of longitudinal data. No patient or public contribution to the analyses were required for testing the differential susceptibility theory. The authors would solicit patient or public contribution when implementing practice or policy changes based on the results.

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Section: Introductionmentioning

confidence: 89%

Section: Environmental Contextmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A test of differential susceptibility in behavior trajectories of preterm infants from preschool to adulthood

Kelly

Arcoleo

D'Agata

et al. 2022

Research in Nursing & Health

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“…As described in studies of resilience and positive adaptation in VPT preschoolers [31,32], VPT children were recruited by contacting families of children treated in the Follow-Up program for a network of neonatal intensive care units affiliated with Nationwide Children's Hospital in Columbus, Ohio USA. To examine outcomes in a higher-risk VPT preschool sample, only children with GA ≤ 30 weeks were included.…”

Section: Samplementioning

confidence: 99%

School Readiness in 4-Year-Old Very Preterm Children

et al. 2022

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The aims of this study were to identify the aspects of school readiness that best distinguish very preterm (VPT) preschoolers from full-term (FT) controls, determine the extent to which readiness problems in the VPT group reflected global cognitive weaknesses or more specific deficits, and identify distinct profiles of readiness problems. Fifty-three VPT (gestational age ≤ 30 weeks) 4-year-olds were compared to 38 FT (gestational age ≥ 37 weeks) controls on measures of global cognitive ability, executive function, motor skills, early literacy and numeracy, and psychosocial functioning. Latent class analysis (LCA) was also conducted to identify individual readiness profiles. The VPT group had the most pronounced difficulties on tests of spatial and nonverbal cognitive abilities, executive function, motor skills, phonological processing, and numeracy. The VPT group also had sex-related difficulties in processing speed, social functioning, and emotion regulation. These differences were evident in analyses of both continuous scores and rates of deficits. The VPT group’s difficulties in motor skills, and VPT females’ difficulties in social functioning and emotion regulation, were evident even when controlling for global cognitive ability. LCA suggested four profiles of readiness, with the majority of the VPT group assigned to profiles characterized by relative weaknesses in either cognitive abilities or psychosocial functioning or by more global readiness problems. The findings support the need to evaluate multiple aspects of school readiness in VPT preschoolers and inform efforts to design more targeted early educational interventions.

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“…Although Louis et al included many possible maternal and neonatal confounders in their models, innumerable medical, social, and parenting factors likely alter the school readiness of preterm-born children. Unmeasured confounders could include noncategorical maternal educational level, neonatal neurological injury (intraventricular hemorrhage and/or periventricular leukomalacia), and specific parenting characteristics (eg, responsivity and structure) …”

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confidence: 99%

Preschool Readiness of Preterm-Born Children—The Hidden Impact of Familial Resilience

2022

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In this issue of JAMA Pediatrics, a large population-based Canadian study by Louis et al 1 reports that children who were born preterm do not "catch up" to their term-born school-aged peers. 1 Extending previous work in children born very preterm, 2,3 the current study found delays across all school readiness domains in children born preterm compared with those born full term, especially among those born at earlier gestational ages (GAs). At first glance, these results seem to merely confirm the findings of previous smaller studies and support what practitioners at high-risk infant follow-up clinics have asserted for years. However, the inclusion in the study of a cohort of preterm-born children with termborn siblings revealed intriguing new findings, challenging historic assumptions about follow-up models and outcomes in preterm-born infants, and suggesting new research possibilities.Louis et al 1 examined school readiness in children born preterm. 1 The outcomes of interest included all 5 domains of the Early Development Instrument (EDI), a validated and wellrounded measure of school readiness. 4 Forty-eight percent of children born at less than 28 weeks' gestation, 40% born at 28 to 33 weeks' gestation, and 34% born at 34 to 36 weeks' gestation scored as vulnerable on the EDI compared with 28% of term-born children. 1 A similar gradient was seen across GAs for children who scored as vulnerable in 3 or more domains of the EDI. 1 Other studies have also found that children born preterm were more likely than their term-born peers to have weaknesses in multiple readiness domains. 2,3 This finding may be attributed to the complexity of developmental sequences necessary to establish functional outcomes across domains. Preterm birth disrupts the entire developmental continuum, with numerous downstream implications. 5 This problem of weaknesses across domains must be addressed because the number of readiness domains affected at age 4 years is a strong factor in educational risk later, even when controlling for socioeconomic status. 3 The results of the study by Louis et al 1 challenge high-risk follow-up models that end routine developmental surveillance at age 2 to 3 years for children born preterm. 1 Although cost, time, and space constraints exist, these care models assume that someone else (family, pediatrician, or school) has the expertise and capacity to provide comprehensive surveillance for these children. Although some preterm-born preschoolers may be ready for school, other such preschoolers demonstrate deficits that may increase along with increases in developmental task difficulties. 2 Researchers have aptly described the "sleeper period" of preschool as a gap between the end of neonatal follow-up and the start of formal school assessments; it is an especially vulnerable period for preterm-born children without major impair-

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Exceeding expectations after perinatal risks for poor development: associations in term- and preterm-born preschoolers

Cited by 6 publications

References 56 publications

A test of differential susceptibility in behavior trajectories of preterm infants from preschool to adulthood

A test of differential susceptibility in behavior trajectories of preterm infants from preschool to adulthood

School Readiness in 4-Year-Old Very Preterm Children

Preschool Readiness of Preterm-Born Children—The Hidden Impact of Familial Resilience

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