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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Impact of Erythropoiesis-Stimulating Agents on Behavioral Measures in Children Born Preterm
Jean R Lowe1, Rebecca E Rieger2, Natalia C Moss2
1Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, NM.
Insights
Erythropoiesis-stimulating agents (ESAs) improved behavior in preterm infants, especially those from lower socioeconomic backgrounds. This benefit was independent of cognitive improvements, suggesting a direct impact on behavioral development.
Area of Science:
- Neonatal Medicine
- Developmental Psychology
- Pediatric Neurology
Background:
- Preterm infants are at risk for developmental challenges.
- Erythropoiesis-stimulating agents (ESAs) are used to stimulate red blood cell production.
- Previous research indicated ESAs improve cognition in preterm infants.
Purpose of the Study:
- To assess the long-term behavioral impact of ESAs administered during infancy.
- To investigate the influence of family demographic factors on these behavioral outcomes.
- To determine if ESA effects on behavior are linked to socioeconomic status.
Main Methods:
- Analysis of children from a prior randomized trial of ESAs versus placebo in preterm infants.
- Inclusion of a healthy term-born control group.
- Behavioral assessment using the Behavioral Assessment System for Children-2 (parent-report).
- Statistical modeling to evaluate study group, sex, and demographic factors (Socioeconomic Composite, Family Stress Composite) as covariates.
Main Results:
- Children who received ESAs showed significantly better behavioral symptom scores compared to the placebo group.
- The ESA group also demonstrated superior scores on externalizing behavior scales.
- A significant interaction between study group and Socioeconomic Composite (SEC) was observed, indicating a greater ESA benefit in children with lower SEC.
Conclusions:
- The positive effects of ESAs on childhood behavior were most pronounced in children with lower socioeconomic status.
- ESAs appear to mitigate the negative behavioral impact associated with lower socioeconomic factors.
- These behavioral benefits are distinct from the previously reported cognitive advantages of ESAs.
Objective:
To evaluate the impact of erythropoiesis-stimulating agents (ESAs) administered during initial hospitalization and family demographic factors on behavior at 3.5-4 years of age.
Study Design:
Children were enrolled who had previously participated in a randomized study of ESAs (n = 35) or placebo (n = 14) in infants born preterm with birth weights of 500-1250 g. A term healthy control group (n = 22) also was recruited. Behavior was evaluated by parent report with the Behavioral Assessment System of Children-2. Principal component analyses identified 2 demographic factors, a Socioeconomic Composite (SEC) and a Family Stress Composite. A multivariate general linear model evaluated the impact of study group and sex on the 4 composite scales of the Behavioral Assessment System of Children-2. Demographic factors were treated as covariates and interactions with study group (ESA, placebo, and term) were examined.
Results:
The ESA group had significantly better scores than the placebo group on behavioral symptoms (P = .04) and externalizing scales (P = .04). An interaction was observed between study group and SEC (P = .001). A beneficial effect of ESAs was maximal in the children with lower SEC scores.
Conclusions:
The beneficial effects of ESAs on childhood behavior were maximal in children with lower SEC scores. ESAs seemed to ameliorate the adverse impact of lower SEC on behavioral domains seen in the placebo group. This effect was independent of the beneficial effect of ESAs on global cognition we reported previously.
Trial Registration:
ClinicalTrials.gov: NCT01207778 and NCT00334737.
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