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Early Mental Trajectories Predict Different Cognitive Levels at School Age in Very Preterm Children
Lan-Wan Wang1,2,3, Yen-Kuang Lin4, Yung-Chieh Lin5,6
1Department of Pediatrics, Chi Mei Medical Center, Tainan, Taiwan.
Insights
Early mental development trajectories in preterm children can predict future intellectual disability or borderline intelligence. Identifying these patterns aids timely interventions for better school-age outcomes.
Area of Science:
- Developmental psychology
- Pediatric neurology
- Public health
Background:
- Early identification of preterm children at risk for intellectual disability (IQ <70) or borderline intelligence (IQ 70-84) is crucial for effective early intervention.
- Preterm birth is associated with increased risk of cognitive impairments, necessitating reliable predictive tools.
Purpose of the Study:
- To investigate if early-life mental trajectories predict intellectual disability and borderline intelligence in school-aged preterm children.
- To assess the predictive power of mental development patterns from infancy for later cognitive outcomes.
Main Methods:
- A multicenter study in Taiwan recruited preterm infants (<32 weeks' gestation) between 2001-2014.
- Mental assessments (Bayley Scales of Infant Development) were conducted at 6, 12, and 24 months corrected age, with IQ measured at 5.5 years.
- Group-based trajectory modeling identified mental trajectories from 6-24 months to predict cognitive outcomes, with model fit assessed by AUROC and AIC.
Main Results:
- Three trajectories were identified: high-stable (59.7%), high-declining (35.3%), and low-declining (5.0%).
- The low-declining trajectory showed significantly higher odds for intellectual disability (37.7-fold), and the high-declining trajectory for borderline intelligence (4.4-fold) compared to normal intelligence.
- Models incorporating trajectory groups improved prediction for intellectual disability (AUROC 0.92) and borderline intelligence (AUROC 0.75) compared to risk factors alone.
Conclusions:
- Early-life mental trajectories are valuable predictors of intellectual disability and borderline intelligence in preterm children at school age.
- These findings support the use of developmental trajectory analysis for targeted early intervention strategies in high-risk preterm populations.
Introduction:
Early identification of preterm children at high risk of intellectual disability (intelligence quotient [IQ] <70) or borderline intelligence (IQ = 70-84) is critical for different early intervention. We investigated whether early-life mental trajectories predict intellectual disability and borderline intelligence, respectively, among school-age preterm children.
Methods:
A multicenter study recruited preterm infants born at <32 weeks' gestation between 2001 and 2014 in Taiwan who underwent mental assessments (Bayley Scales of Infant Development) at corrected ages 6, 12, and 24 months and IQs at age 5.5 years. Mental trajectories from ages 6 to 24 months determined using group-based trajectory modeling were employed to predict intellectual disability and borderline intelligence, respectively. Model fit was assessed using the area under the receiver operating characteristic curve (AUROC) and Akaike information criterion (AIC).
Results:
Among the 1,680 children enrolled, three mental trajectories were identified: high-stable (59.7%), high-declining (35.3%), and low-declining (5.0%), in which the borderline-intelligence/intellectual-disability rate was 14.1%/1.5%, 36.1%/13.7%, and 10.7%/82.1%, respectively. Compared with children with normal intelligence, the low-declining trajectory had 37.7-fold higher odds (95% confidence interval [CI], 26.3-48.1) for intellectual disability, and the high-declining trajectory had 4.4-fold higher odds (95% CI, 3.1-6.1) for borderline intelligence. Compared to the models with risk factors alone (AIC 1,791.2), the models that included both risk factors and trajectory groups had better overall performance (AIC 1,419.8) and increased prediction power for intelligence outcomes: low-declining trajectory for intellectual disability (AUROC increased from 0.81 to 0.92) and high-declining trajectory for borderline intelligence (AUROC increased from 0.68 to 0.75).
Conclusions:
Early-life mental trajectories help identify preterm children at risk of intellectual disability and borderline intelligence, respectively, at school age for timely intervention.
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