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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
The intersection of neuroscience, socioeconomic status, and preterm birth
Alexandra F Bonthrone1,2,3, Steven P Miller4,5, James P Boardman6,7
1Research Department of Early Life Imaging, Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
Insights
Socioeconomic status significantly impacts neurodevelopment in very preterm infants, affecting brain structure and cognitive outcomes. Addressing social disadvantage is crucial for improving long-term health and development in these children.
Area of Science:
- Neonatal neuroscience
- Developmental pediatrics
- Social epidemiology
Background:
- Preterm birth is a major cause of childhood neurodevelopmental impairment.
- While medical factors are known risks, socioeconomic inequalities are increasingly recognized as significant contributors.
- Understanding these social determinants is vital for improving outcomes.
Purpose of the Study:
- To review evidence linking socioeconomic status (SES) to brain injury/dysmaturation and neurocognitive outcomes in very preterm children.
- To explore mechanisms by which SES influences development in this vulnerable population.
- To identify potential interventions and policy targets.
Main Methods:
- Systematic review of etiological evidence.
- Analysis of studies using magnetic resonance imaging (MRI) for brain assessment.
- Examination of cognitive and behavioral outcome data from birth to five years.
Main Results:
- Social gradients strongly influence neurodevelopmental trajectories after preterm birth.
- Lower socioeconomic status is associated with altered brain structure and connectivity in preterm infants.
- These associations persist despite accounting for medical risks.
Conclusions:
- Socioeconomic disadvantage is a critical determinant of brain development and neurocognitive outcomes in preterm children.
- Mitigating social disadvantage during the perinatal period and early childhood is essential.
- Interventions should address both social and medical factors to improve long-term outcomes.
Abstract:
Preterm birth is a leading cause of brain dysmaturation and neurocognitive impairment in childhood. While both dysmaturation and adverse outcomes are often attributed to low gestational age and PTB-associated risk factors such as chorioamnionitis, immune dysregulation, suboptimal nutrition, and common co-morbidities, recent studies suggest socioeconomic inequalities also play an important role. In this review, we summarize current etiological evidence linking socioeconomic status with i) brain injury/dysmaturation defined using magnetic resonance imaging, and ii) cognitive and behavioral outcomes, in very preterm children from birth to five years. We consider the mechanisms that may embed socioeconomic status in the development of children who were born preterm, including in response to prevalent brain injuries. We discuss the potential role of access to cognitive, social, and economic resources for attenuating the effects of social disadvantage and suggest targets for future research and policy change. IMPACT: Social gradients are strong determinants of neurodevelopmental outcomes after preterm birth. Social disadvantage is associated with brain structure and connectivity in preterm infants. Improving outcomes after preterm birth is likely to require mitigating social disadvantage in the perinatal period and early childhood, as well as reducing medical risks linked to atypical development.
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