Risk factors for emotional and behavioral problems in moderately-late preterms

Area of Science:

• Pediatrics
• Developmental Psychology
• Neonatology

Background:

• Moderately-late preterm born children (MLPs), born between 32.0-35.9 weeks gestation, face increased risks for emotional and behavioral problems compared to full-term infants.
• Existing research on risk and protective factors for these issues in MLPs is limited, highlighting a need for further investigation.

Purpose of the Study:

• To identify maternal, lifestyle, pregnancy, delivery, fetal, and neonatal factors associated with emotional and behavioral problems in MLPs at 4 years of age.
• To adjust for socio-economic status when examining these associations.
• To inform potential preventive interventions for MLPs.

Main Methods:

• Prospective, community-based study (Longitudinal Preterm Outcome Project - LOLLIPOP) involving 809 MLPs.
• Assessment of emotional and behavioral problems using the parent-reported Child Behavior Checklist (CBCL) between 41 and 49 months corrected age.
• Collection of risk factors from hospital records and parental questionnaires, followed by univariable and multiple logistic regression analyses.

Main Results:

• Perinatal infection significantly increased the risk of total behavioral problems (OR 2.22, p<0.01).
• Maternal smoking, male gender, and perinatal infection were associated with increased externalizing problem scores (ORs 1.64-2.46, p<0.05).
• Multiple birth was found to be a protective factor against internalizing problem scores (OR 0.63, p<0.05).

Conclusions:

• Male gender, perinatal infection, and maternal smoking are identified risk factors for behavioral problems in MLPs.
• Maternal smoking and perinatal infection are potentially modifiable risk factors.
• Multiple birth demonstrates a protective effect on emotional problems in MLPs, suggesting targeted intervention strategies for this significant preterm population.