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Behaviour at 2 years of age in very preterm infants (gestational age < 32 weeks)
G M S J Stoelhorst1, S E Martens, M Rijken
1Department of Paediatrics, Leiden University Medical Centre, The Hague, The Netherlands.
Insights
Behavioral problems in very premature infants at 2 years corrected age are comparable to the general population. However, infants born small for gestational age or with neurological issues show higher rates of anxious, depressed, or withdrawn behaviors.
Area of Science:
- Neonatalogy
- Developmental Pediatrics
- Child Psychology
Background:
- Very premature infants (gestational age < 32 weeks) face potential developmental challenges.
- Understanding behavioral outcomes in this population is crucial for early intervention.
Purpose of the Study:
- To determine behavioral outcomes at 2 years corrected age in very premature infants.
- To identify risk factors associated with abnormal behavior in this cohort.
Main Methods:
- Prospective, regionally defined cohort study of liveborn infants < 32 weeks gestational age.
- Behavioral assessment using the Child Behaviour Checklist 2-3 at 2 years corrected age.
- Analysis of 158 questionnaires from 206 survivors (77% follow-up rate).
Main Results:
- 9% of very premature infants exhibited behavioral problems in the clinical range, comparable to the general population.
- Risk factors for higher behavioral scores included lower gestational age, being small for gestational age, neurological abnormalities, and non-Dutch origin.
- Neurological abnormalities at 2 years and being small for gestational age were significantly associated with anxious/depressed and withdrawn behaviors after controlling for confounders.
Conclusions:
- The prevalence of behavioral problems in very premature infants is similar to that in the general population.
- Small for gestational age status and neurological abnormalities at 2 years are key predictors of specific behavioral issues, particularly anxious/depressed and withdrawn behaviors.
Aim:
The objective of this study was to determine behavioural outcome and risk factors for abnormal behaviour at 2 y corrected age in very premature infants in a regionally defined, prospective cohort study.
Methods:
The Leiden Follow-Up Project on Prematurity includes all liveborn infants of < 32 wk gestational age, born in 1996/1997 (n = 266). Behaviour was assessed with the Child Behaviour Checklist 2-3.
Results:
An analysis of 158 questionnaires of 206 survivors (77%) was carried out. Fourteen children (9%) had a total problem score > p90 ("clinical range"). This percentage is comparable with the 10% found in a sample of 2- to 3-y-olds from the Dutch general population. Univariate analysis showed higher syndrome scale scores in one or more of the Child Behaviour Checklist scales in children of lower gestational age, small for gestational age (birthweight < p10), with neurological abnormalities at term or at 2 y and of non-Dutch origin. Lower socioeconomic status and postnatal treatment with dexamethasone were associated with higher scores in the somatic problems scale and lower maternal age at birth with a higher total problem score. After correction for confounding variables, the associations between small for gestational age, neurological abnormalities at 2 y and the anxious/depressed and/or withdrawn scales remained significant.
Conclusion:
The prevalence of behavioural problems at 2 y corrected age in this cohort of very premature infants (gestational age < 32 wk) was comparable with that in a general population sample. Children born small for gestational age or with neurological abnormalities at 2 y of age had higher syndrome scale scores, mainly for anxious/depressed and/or withdrawn behaviour.