Trajectories of Externalizing and Internalizing Behaviors in Preterm Children Admitted to a Neonatal Intensive Care Unit

Abstract

Objective To examine trajectories of internalizing and externalizing behavior problems of preterm children between 16 months and 6 years of age and predictors of trajectories, including gestational age, child dysregulation, maternal depression, socioeconomic status, and parenting. Study design This longitudinal study followed 148 children and their mothers from Neonatal Intensive Care Unit (NICU) discharge until age 6. Gestational ages ranged from 23–36 weeks. The study included assessment of maternal-reported behavior problems, maternal depression, neonatal and socioeconomic characteristics, and observations of dysregulated behavior and parenting. Trajectories were identified with a semi-parametric group-based analytic method, and multinomial logistic regression was used to identify significant risk factors. Results Three distinct trajectories for preterm children were found for both internalizing and externalizing behavior problems. For the two groups with greater behavior problems (Groups 1 and 2), trajectories reached their peak between 24–36 months of age, then leveled off or decreased. Group 3 showed a stable low level of externalizing behaviors, and a low, but slightly increasing level of internalizing behaviors. Maternal depression, child dysregulation, gestational age, and socioeconomic challenges were identified as risk factors that predicted less optimal behavior problem trajectories. Conclusions Children born prematurely followed one of three distinct developmental trajectories for both internalizing and externalizing behavior problems. The most severe behavior problems started early in development and were associated with increased child dysregulation, maternal depression, and lower socioeconomic status. These findings have implications for screening and monitoring preterm children.

Do healthy preterm children have behavior problems?

“…In any case the effect of the three variables of Model 1 (gestational age, gender and maternal education) on behavior problems was low (4% or 5 % of variance explained). Therefore, our results are in line with other studies in which a significant effect of maternal education was found on externalizing (Schappin et al, 2018), or internalizing and total problems at 6 years of age (Cassiano et al, 2018;Gerstein et al, 2017;Santos et al, 2017;Rose et al, 1992;), with a similar percentage of variance explained (7%).…”

“…Our results confirm that GA does not seem to have a predictive role on behavior problems (Arpi & Ferrari, 2013;Cassiano et al, 2016;Cassiano et al, 2017;Cassiano et al, 2018;Gerstein et al, 2017;Santos et al, 2017), while other factors seem to have a higher predictive effect on behavior problems than GA; gender however, has no predictive effect on behavior problems, which is in agreement with Loe, Heller & Chatav (2019) findings.…”

“…The inconsistencies in the rates of behavior problems found may be due not only to wide variations in the degree of prematurity or birth-weight, but also to other factors such as: the existence of medical complications, the quality of the environment and mother-child interactions in the samples studied (Arpi & Ferrari, 2013;Rose et al, 1992), the age of assessment (Gerstein, Woodman, Burnson, Cheng and Poehlmann-Tynan, 2017;Schappin, Wijnroks, Venema & Jongmans, 2018) and the particular instrument of assessment used.…”

“…Although those children with lower GA tend to have higher scores in the instruments assessing behavioral problems, different review studies show that GA is not a predictor of behavioral problems (Arpi & Ferrary, 2013;Cassiano et al, 2016). Other empirical cross-sectional (Cassiano, Gaspardo, Faciroli, Martínez and Linhares, 2017;Cassiano, Provenzi, Linhares, Gaspardo & Montirosso, 2018) or longitudinal studies (Gerstein et al, 2017;Santos, Barros, Munhoz and Matijasevich, 2017) found no significant effect of GA on behavior problems for PT children at different ages (in a range between 16 months up to 11 years of age).…”

Screening for Autism Spectrum Disorder in Premature Subjects Hospitalized in a Neonatal Intensive Care Unit

“…Premature birth interrupts this structural development, which then becomes dependent on the care of a neonatal intensive care unit (NICU) [ 1 , 2 ]. Despite the fact that the NICU provides essential life support for the newborn, internal organic factors and intense exposures may affect the trajectory of its development [ 3 , 4 ]. The longer the NICU stay, the greater the benefit and recovery of neuromotor and cognitive functions [ 5 ].…”