Neurobehavioral Phenotype and Dysexecutive Syndrome of Preterm Children: Comorbidity or Trigger? An Update

Abstract

Premature birth is a worldwide public health priority. One in ten children is born before 37 weeks of gestational age and, in developed countries, survival rates without major neonatal morbidity are increasing. Although severe sequelae associated with these births have decreased, their neurobehavioral difficulties, often associated in multiple fields, remain stable but still widespread. These neurobehavioral difficulties hamper the normal development of academic achievements and societal integration and intensify the children’s needs for rehabilitation during their preschool and academic years. Severe sequelae increase when gestational age decreases. This is even truer if the socio-cultural background is impeded by low income, education and language skills as compared with defined averages. However, moderate and/or minor neurocognitive and/or behavioral difficulties are almost identical for a moderate or a late preterm birth. Obtaining a better clinical description of neurobehavioral characteristics of those pretermly born, once they reach preschool age, is essential to detect behavioral issues as well as early specific cognitive difficulties (working memory, planning, inhibition, language expression and reception, attention and fine motor skills, etc.). Such information would provide a better understanding of the executive functions’ role in brain connectivity, neurodevelopment and neuroanatomical correlation with premature encephalopathy.

Chorionicity and neurodevelopmental outcomes at 5½ years among twins born preterm: the EPIPAGE2 cohort study

“…In particular they are likely to have a lower total intelligence quotient (FSIQ) than that of the general population 23 . However, in cohorts of premature infants an FSIQ threshold close to a low mean (as assessed by WPPSI‐IV) is generally considered ‘normal’, although the observed performances are the result of complex processes involving multiple intellectual and non‐intellectual characteristics, such as attention, emotions, motivation, planning of movements and executive functions 10 . The multicentric and national nature of the recruitment of the EPIPAGE2 cohort provided a good representation of the various treatments occurring in 2011 in France.…”

“…Conversely, other authors have shown that, after 2 years, neurodevelopmental difficulties were more marked in MC twins compared with DC twins 8,9 . A neurodevelopmental assessment is necessary at a later age (school age) because it is more reliable 10 …”

“…23 However, in cohorts of premature infants an FSIQ threshold close to a low mean (as assessed by WPPSI-IV) is generally considered 'normal', although the observed performances are the result of complex processes involving multiple intellectual and non-intellectual characteristics, such as attention, emotions, motivation, planning of movements and executive functions. 10 The multicentric and national nature of the recruitment of the EPIPAGE2 cohort provided a good representation of the various treatments occurring in 2011 in France. The main limitation of this study is the proportion of missing data related to children lost to follow-up at 5½ years, although attrition bias remains moderate given the size of the cohort.…”

“…8,9 A neurodevelopmental assessment is necessary at a later age (school age) because it is more reliable. 10 Independently of the specific perinatal complications of chorionicity, we hypothesized that chorionicity could play a substantial role in the long-term neurodevelopment of preterm newborns. We aimed to assess the association between chorionicity and neurodevelopmental outcomes at 5 years among twins in a cohort of very preterm infants.…”

Neuronal oscillations: early biomarkers of psychiatric disease?

“…Subsequent desynchronization of activity mirrors the increasing influence of sensory inputs shaping neuronal activity (Toyoizumi et al, 2013 ). Notably, due to different types of processed information and timelines of circuit assembly, different areas and functions exhibit distinct sensitive periods of maturation, e.g., the human visual system being particularly sensitive during the first few years of life, while language acquisition is sensitive during the first year after birth (Wiesel, 1982 ; Daw, 1998 ; Anderson and Reidy, 2012 ; Friedmann and Rusou, 2015 ; Gire et al, 2022 ). Similarly, in rodents, experience shapes synaptic circuits of visual and auditory systems during periods of enhanced plasticity, following eye/ear opening (Lehmann and Löwel, 2008 ; Rinaldi Barkat et al, 2011 ).…”