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Differentiating the Preterm Phenotype: Distinct Profiles of Cognitive and Behavioral Development Following Late and

Samantha Johnson¹, Ghazala Waheed¹, Bradley N Manktelow¹

¹Department of Health Sciences, University of Leicester, Leicester, UK.

The Journal of Pediatrics

|December 20, 2017

Insights

Children born late or moderately preterm (LMPT) often show developmental issues similar to term-born peers. However, a distinct "very preterm phenotype" of impairments suggests prematurity impacts development through multiple pathways.

Area of Science:

Developmental Pediatrics
Neonatology
Child Psychology

Background:

Late and moderately preterm (LMPT) birth (32-36 weeks gestation) is common.
Cognitive and behavioral outcomes in LMPT infants require further investigation.
Understanding comorbidity patterns is crucial for targeted interventions.

Purpose of the Study:

To explore comorbidity patterns in cognitive and behavioral outcomes at 2 years corrected age for LMPT infants.
To identify predictors of different comorbidity patterns in LMPT children.
To compare outcomes between LMPT and term-born infants.

Main Methods:

Prospective, population-based cohort study.
Included 1139 LMPT infants and 1255 term-born infants.
Parent questionnaires assessed development at 24 months corrected age using latent class analysis.

Main Results:

Two developmental profiles (optimal, nonoptimal) were found in both LMPT and term groups.
LMPT infants also showed a third profile, similar to the 'very preterm phenotype'.
Risk factors for nonoptimal outcomes included nonwhite ethnicity, socioeconomic risk, and lack of breastfeeding.

Conclusions:

Most LMPT infants with impairments resemble term-born peers.
A subset of LMPT infants exhibits a distinct 'very preterm phenotype'.
Prematurity may influence development via multiple etiological pathways.

Read full analysis

Abstract

Objectives:

To explore patterns of comorbidity in cognitive and behavioral outcomes at 2 years' corrected age among children born late or moderately preterm (LMPT) and to identify predictors of different patterns of comorbidity.

Study Design:

Geographical, prospective population-based cohort study of 1139 infants born LMPT (32^0/7 to 36^6/7 weeks' gestation) and 1255 infants born at term (37^0/7 to 42^6/7 weeks' gestation). Parent questionnaires were obtained to identify impaired cognitive and language development, behavioral problems, delayed social-emotional competence, autistic features, and clinically significant eating difficulties at 24 months corrected age for 638 (57%) children born LMPT and 765 (62%) children born at term.

Results:

Latent class analysis revealed 2 profiles of development among the term group: optimal (84%) and a profile of social, emotional, and behavioral impairments termed "nonoptimal" (16%). These 2 profiles were also identified among the LMPT group (optimal: 67%; nonoptimal: 26%). In the LMPT group, a third profile was identified (7%) that was similar to the phenotype previously identified in infants born very preterm. Nonwhite ethnicity, socioeconomic risk, and not receiving breast milk at hospital discharge were risk factors for nonoptimal outcomes in both groups. Male sex, greater gestational age, and pre-eclampsia were only associated with the preterm phenotype.

Conclusions:

Among children born LMPT with parent-reported cognitive or behavioral impairments, most had problems similar to the profile of difficulties observed in children born at term. A smaller proportion of children born LMPT had impairments consistent with the "very preterm phenotype" which are likely to have arisen through a preterm pathway. These results suggest that prematurity may affect development through several etiologic pathways in the late and moderately preterm population.

Keywords:

cognition comorbidity development language preterm

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