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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Neuropsychological and behavioral outcomes of extremely low birth weight at age three
Ida Sue Baron1, Kristine Erickson, Margot D Ahronovich
1Department of Pediatrics, Inova Fairfax Hospital for Children, Falls Church, Virginia 22042, USA. ida@isbaron.com
Insights
Preterm birth (PT) and extremely low birth weight (ELBW) infants show subtle neuropsychological and behavioral delays by age 3. These early deficits highlight neurobiological immaturity
Area of Science:
- Developmental neuroscience
- Pediatric neurology
- Child psychology
Background:
- Preterm birth (PT) is linked to increased mortality and morbidity.
- Neuropsychological and behavioral outcomes in preschool-aged children born preterm are understudied.
- Extremely low birth weight (ELBW) is a critical factor in preterm infant development.
Purpose of the Study:
- To compare neuropsychological and behavioral outcomes at age 3 in preterm/ELBW children versus term-born peers.
- To identify specific developmental areas affected by preterm birth and gestational age.
- To assess the impact of age correction on outcome measures.
Main Methods:
- Comparison of a preterm/ELBW cohort (N=60, ≤33 weeks gestation, <1000g) with a term-born cohort (N=90) at age 3.
- Assessment of verbal, nonverbal, motor, executive, and communication skills.
- Utilized parental behavioral reports and age-corrected scores.
Main Results:
- PT/ELBW subgroups performed significantly poorer than term-born children on multiple measures, including verbal, nonverbal, motor, and communication skills.
- Children born <26 weeks showed additional deficits in action-verb fluency.
- Executive and adaptive deficits were noted in PT/ELBW children born 26-33 weeks.
- Age correction improved PT scores but did not mask underlying relative weaknesses.
Conclusions:
- Subtle neuropsychological and behavioral delays are measurable in 3-year-olds born preterm.
- Neurobiological immaturity significantly influences preschool outcomes.
- Early identification and intervention are crucial for PT/ELBW children to address developmental weaknesses.
Abstract:
Preterm (PT) birth is an established risk factor for high mortality and morbidity rates. Infants and school-aged children have been well-studied, but few have described neuropsychological and behavioral outcomes at preschool age. We compared a 2004-2006 preterm/extremely low birth weight (ELBW) cohort (PT/ELBW; N = 60) born ≤ 33 weeks gestation and <1,000 g with term-born participants (N = 90) at age 3. PT/ELBW subgroups (<26 weeks; 26-33 weeks) performed more poorly than the term-born group on verbal, nonverbal, fine motor, visual-motor, visual attention, noun fluency, early number concepts, and functional communication measures prior to age correction; PT/ELBW children born <26 weeks additionally performed more poorly on action-verb fluency. Those born 26-33 weeks had executive and adaptive deficits on parental behavioral report. Age correction significantly improved preterm scores without masking relative verbal, nonverbal, motor, and behavioral weaknesses that may require early intervention. In conclusion, subtle delays in emergent neuropsychological and behavioral functions are measurable at age 3, and neurobiological immaturity remains a prepotent influence on outcome in the preschool years. Further study should enhance our understanding of the trajectory of brain development and the limits of neuroplasticity in these highly at-risk children.
