Trajectories of behavior, attention, social and emotional problems from childhood to early adulthood following extremely preterm birth: a prospective cohort study

Abstract

To investigate trajectories of behavior, attention, social and emotional problems to early adulthood in extremely preterm survivors compared to a term-born comparison group. Longitudinal analysis of a prospective, population-based cohort of 315 surviving infants born < 26 completed weeks of gestation recruited at birth in 1995, from the UK/Republic of Ireland, and a term-born comparison group recruited at age 6. The parent-report Strengths and Difficulties Questionnaire was completed at age 6, 11, 16 and 19 years. The Total Behavioral Difficulties Score was 4.81 points higher in extremely preterm individuals compared to their term-born peers over the period (95% CI 3.76-5.87, p < 0.001) and trajectories were stable in both groups. The impact of difficulties on home life, friendships, school or work and/or leisure activities was greater in the EPT group (RR 4.28, 95% CI 2.89-6.35, p < 0.001), and hyperactivity/inattention and peer problems accounted for the largest differences. A clinically significant behavioral screen at age 2.5 was associated with a higher Total Behavioral Difficulties Score from 6 years onwards in extremely preterm participants (Mean difference 6.90, 95% CI 5.01-8.70, p < 0.0.01), as was moderate/ severe cognitive impairment at last assessment (Mean difference: 4.27, 95% CI 2.76-5.77, p < 0.001). Attention, social and emotional problems in extremely preterm individuals persist into early adulthood with significant impact on daily life. A positive behavioral screen in infancy and moderate/severe cognitive impairment are associated with early adult outcomes.

Young Adult Motor, Sensory, and Cognitive Outcomes and Longitudinal Development after Very and Extremely Preterm Birth

“…Linsell et al (2018) examined trajectories between the age of 6 and 19 years for extremely preterm individuals in the EPICure study, using the Strengths and Difficulties Questionnaire. 63 Scores for inattention and hyperactivity were persistently higher in the preterm group than the term born group. Trajectories over time were similar; however, a slight decline in inattention and hyperactivity symptoms from childhood to adulthood was seen in the preterm group, which is different to what was observed in the Bavarian Longitudinal Study cohort.…”

Developmental Outcomes of Extremely Preterm Infants with a Need for Child Protective Services Supervision

“…25,26 Because preterm infants are at increased risk for similar behavioral problems over time, longitudinal mental health evaluation of the EPT children in CPS is warranted. 27,28 Poor growth is common among EPT infants. 29 The CPS group had a larger head circumference at 36 weeks postmenstrual age, but at 2 years demonstrated a greater lag in head circumference, and length, compared with the non-CPS group.…”

Placental programming, perinatal inflammation, and neurodevelopment impairment among those born extremely preterm

“…14,15 Thus, an important research priority are studies of adults born extremely preterm. [16][17][18]…”