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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Predictors of persistent and changing developmental problems of preterm children
Arend F Bos1, Jorijn Hornman2, Andrea F de Winter2
1Beatrix Children's Hospital, Division of Neonatology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
Insights
Predicting developmental problems in preterm children is crucial for early intervention. Specific perinatal and social factors, like maternal mental illness and small-for-gestational age birth, significantly improve prediction accuracy for these children.
Area of Science:
- Pediatrics
- Developmental Psychology
- Public Health
Background:
- Accurate prediction of developmental problems in preterm-born children is essential for timely and targeted interventions.
- Understanding the trajectory of developmental issues from early childhood to school entry is critical.
Purpose of the Study:
- To identify perinatal and social factors associated with persistent, emerging, and resolving developmental problems in early-preterm (EP) and moderately-and-late-preterm (MLP) children.
- To assess the predictive value of these factors for developmental outcomes from before to after school entry.
Main Methods:
- A longitudinal observational cohort study involving 341 EPs and 565 MLPs.
- Developmental problems were assessed using the Ages and Stages Questionnaire at ages 4 and 5.
- Logistic regression analyses were employed to examine associations between 48 perinatal and social factors and developmental problem trajectories.
Main Results:
- Persistent problems were observed in 8.7% of EPs and 4.3% of MLPs; emerging problems affected 5.1% of EPs and 1.9% of MLPs.
- Key predictors for persistent problems included maternal chronic mental illness, male sex, small-for-gestational age (SGA) birth, and multiparity.
- Prolonged premature rupture of membranes (PPROM) in MLPs predicted emerging problems. The inclusion of identified risk factors improved prediction model variance from 3.0% to 21.9%.
Conclusions:
- Few perinatal and social factors consistently predicted developmental problems across both EP and MLP groups.
- Neonatal conditions like SGA and PPROM in MLPs are associated with persistent developmental issues.
- Identifying specific risk factors significantly enhances the prediction of developmental problems in preterm children, enabling better intervention strategies.
Background:
Accurate prediction of persistent and emerging developmental problems in preterm-born children may lead to targeted interventions.
Aims:
To determine whether specific perinatal and social factors were associated with persistent, emerging, and resolving developmental problems of early-preterm (EPs) and moderately-and-late-preterm children (MLPs) from before to after school entry.
Study Design:
Observational longitudinal cohort study, part of the LOLLIPOP cohort-study.
Subjects:
341 EPs and 565 MLPs.
Outcome Measures:
Developmental problems using the Ages and Stages Questionnaire at ages 4 and 5. We collected data on perinatal and social factors from medical records. Using logistic regression analyses we assessed associations between 48 factors and persistent, emerging, and resolving problems.
Results:
Of EPs, 8.7% had persistent and 5.1% emerging problems; this was 4.3% and 1.9% for MLPs, respectively. Predictors for persistent problems included chronic mental illness of the mother, odds ratio (95% confidence interval) 8.01 (1.85-34.60), male sex 4.96 (2.28-10.82), being born small-for-gestational age (SGA) 2.39 (1.15-4.99), and multiparity 3.56 (1.87-6.76). Predictors for emerging problems included MLP birth with prolonged premature rupture of membranes (PPROM) 5.01 (1.38-18.14). Including all predictors in a single prediction model, the explained variance (Nagelkerke R2) was 21.9%, whereas this was 3.0% with only EP/MLP birth as predictor.
Conclusions:
Only few perinatal and social factors had associations with persistent and emerging developmental problems for both EPs and MLPs. For children with specific neonatal conditions such as SGA, and PPROM in MLPs, problems may persist. Insight in risk factors largely improved the prediction of developmental problems among preterm children.
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