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Published on: August 7, 2017
The Inter-Relationships of Extremely Low Birth Weight, Asthma, and Behavior: A Study of Common Cause, Mediation, and
Jonathan S Litt1, Nori Minich2, H Gerry Taylor3
1Department of Neonatology, Beth Israel Deaconess Medical Center (JS Litt), Boston, Mass; Department of Pediatrics, Harvard Medical School (JS Litt), Boston, Mass; Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health (JS Litt and H Tiemeier), Boston, Mass.
Insights
Extremely low birth weight (ELBW) is linked to asthma and behavioral issues in children. However, asthma does not cause or worsen these neurodevelopmental problems in ELBW infants.
Area of Science:
- Neonatal Medicine
- Developmental Pediatrics
- Child Psychology
Background:
- Infants with extremely low birth weight (ELBW) face risks for both asthma and neurodevelopmental issues, including inattention, hyperactivity, anxiety, and depression.
- While asthma is known to predict behavioral problems in full-term children, the specific interplay between ELBW, asthma, and behavioral/emotional outcomes remains unclear.
Purpose of the Study:
- To investigate the relationship between extremely low birth weight (ELBW), asthma, and behavioral and emotional problems in children at school age.
- To test models of independent risk, mediation, and effect modification to understand the interplay among birth weight, asthma, and neurodevelopmental outcomes.
Main Methods:
- A prospective cohort study followed extremely low birth weight (ELBW) infants and normal birth weight (NBW) children from birth to 8 years of age.
- Data collection included parent-reported asthma diagnosis and symptoms of inattention, hyperactivity, anxiety, and depression at age 8.
- Covariates such as child sex and maternal socioeconomic status were considered.
Main Results:
- ELBW children exhibited significantly higher rates of asthma (35.7%) compared to normal birth weight (NBW) children (14.4%).
- Children with ELBW and those with asthma reported higher scores for inattention, hyperactivity, depression, and anxiety.
- Asthma was identified as a common cause of anxiety in ELBW children, but it did not mediate or modify the effect of ELBW on behavioral and emotional symptoms.
Conclusions:
- Asthma does not appear to be a causal factor or amplifier for behavioral and emotional problems in school-aged children born with extremely low birth weight (ELBW).
- The increased risks for respiratory morbidity and neurodevelopmental issues in ELBW infants likely represent independent consequences of their initial developmental vulnerability.
- Further research with larger cohorts and longitudinal symptom tracking may be needed to fully elucidate the complex relationship between chronic conditions and neurodevelopment.
Background:
Extremely low birth weight (ELBW; <1000 g) infants are at risk for both asthma and problems like inattention, hyperactivity, anxiety, and depression. Asthma predicts behavioral and emotional problems in term-born children. The nature of these associations is poorly understood. We tested 3 models of association: independent risk, mediation, and effect modification to explore interplay among birth weight, asthma, and behavioral and emotional problems.
Methods:
We used data from a prospective cohort of ELBW infants born 1992 to 1995. Exposure was ELBW; primary outcomes were parent-reported diagnosis of asthma and symptoms of inattention, hyperactivity, anxiety, and depression at age 8 years. Covariates included child sex and maternal socioeconomic status.
Results:
There were 139 ELBW and 101 normal BW (>2500 g) children followed to 8 years. ELBW children were more likely to have asthma (35.7% vs 14.4%, P < .05). Inattention, hyperactivity, depression, and anxiety scores were higher among ELBW children and children with asthma. ELBW was a common cause of asthma and anxiety. There was no evidence of mediation or effect modification by asthma on the effect of ELBW on behavior and emotion symptoms.
Conclusion:
Asthma does not underlie or amplify the effect of ELBW on behavioral and emotional problems at school age, suggesting that increased risk for respiratory morbidity and neurodevelopment represent largely independent consequences of developmental vulnerability related to ELBW. Noting the impact of chronic illnesses on neurodevelopment in other populations, data focused on symptom trajectories over time in a larger cohort may be necessary to shed further light onto this question.
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