Academic, social, and behavioral outcomes at age 12 of infants born preterm

Web-based early intervention for children with motor difficulties aged 3–8 years old using multimodal rehabilitation (WECARE): protocol of a patient-centred pragmatic randomised trial of paediatric telerehabilitation to support families

Introduction

Mild motor difficulties in children are underdiagnosed despite being highly prevalent, leaving such children often underserved and at higher risk for secondary consequences such as cardiovascular disease and anxiety. Evidence suggests that early patient-oriented interventions, coaching parents and providing children with early stimulation should be provided, even in the absence of a diagnosis. Such interventions may be effectively delivered via telerehabilitation.

Methods and analysis

A family-centred, pragmatic randomised controlled trial will be carried out to evaluate the real-world effectiveness of a Web-based Early intervention for Children using multimodAl REhabilitation (WECARE). Families of children with motor difficulties, 3–8 years of age, living in Quebec, Canada, and receiving no public rehabilitation services (n=118) will be asked to determine up to 12 performance goals, evaluated using the Canadian Occupational Performance Measure (COPM, the primary outcome). Families will be randomised to receive either usual care or the WECARE intervention. The WECARE intervention will be delivered for 1 year via a web-based platform. Families will have access to videoconferences with an assigned rehabilitation therapist using a collaborative coaching approach, a private chat function, a forum open to all intervention arm participants and online resources pertaining to child development. Participants will be asked to re-evaluate the child’s COPM performance goals every 3 months up to 1 year post allocation. The COPM results will be analysed using a mixed Poisson regression model. Secondary outcomes include measures of the child’s functional ability, parental knowledge and skills and health-related quality of life, as well as qualitative outcomes pertaining to parental satisfaction and service delivery trajectories. Investigators and quantitative data analysts will be blinded to group allocation.

Ethics and dissemination

The CIUSSS de l’Estrie—CHUS ethics committee approved this trial (2020-3429). Study results will be communicated via peer-reviewed journal publications, conference presentations and stakeholder-specific knowledge transfer activities.

Trial registration number

NCT04254302.

Emerging atypical connectivity networks for processing angry and fearful faces in very preterm born children

Very preterm born (VPT) children are those born before 32/40 weeks' gestational age and comprise 10% of the 15 million babies born prematurely worldwide each year. Due to advancements in neonatal medicine, the survival rate of VPT birth has increased, but few studies have investigated the nonmedical, social-cognitive morbidities that affect these children. In this study, we examined emotional face processing networks in VPT compared to age and sex matched full-term born (FT) children. Magnetoencephalography (MEG) was used to test VPT and FT born children at 6 years (n = 78) and 8 years (n = 83). Children were assessed using an implicit emotion face-processing task. Happy, fearful, and angry faces were presented for 150 ms, but children were asked to respond by button press to the location of a control pixelated image of the face displayed on the side of the screen opposite to the face. Children rated the valence of the images on a five-point scale. Group differences showed that VPT children rated angry faces more positively than their FT peers. VPT children had reduced connectivity for angry and fearful faces at 8 years in networks including regions such as the bilateral amygdala, superior temporal sulci, and anterior cingulate gyrus. Interventions should target both emotion recognition, as well as higher cognitive processes related to emotional control and thinking about one's own emotions.

Trajectories of problem behaviors from 4 to 23 years in former preterm infants

Premature infants have significant risk for later behavior problems. This study examined growth trajectories of three problem behaviors across five developmental age points from preschool to early adulthood in a well-characterized sample of premature infants. The effects of neonatal risk, gender, and socioeconomic context were modeled on these trajectories. The longitudinal sample was comprised of preterm infants (N = 160) with full variation of neonatal morbidity and birth weight (640-1950 grams). Trajectories of externalizing, internalizing and attention problem behaviors from 4 to 23 years, measured by the Child Behavior Checklist, were tested using latent growth curve modeling. The results indicate individual variation in the number of externalizing and internalizing problems over time. Externalizing problems were not significantly different for males and females, but male scores were consistently higher. Neonatal risk was significantly associated with higher internalizing problems at age 4, but was not predictive at school age and beyond. Attention problem scores increased from early preschool through adolescence for males, but females had little change over the same ages. SES was not predictive of any problem behavior trajectories and no significant two-way interactions were found. The results advance understanding of stability and change of three important problem behaviors through preschool, childhood and adolescence to young adulthood in prematurely born infants in order to inform clinicians about timely assessment and the refinement of effective interventions.

Social Emotional Factors Increase Risk of Postpartum Depression in Mothers of Preterm Infants

OBJECTIVE

To examine the association of maternal mental health, perceptions of readiness at neonatal intensive care unit (NICU) discharge, and social risk factors with depressive symptoms 1 month postdischarge in mothers of early (<32 weeks), moderate (32-33 weeks), and late (34-36 weeks) preterm infants. A secondary objective was to compare depressive symptoms among mothers in all preterm groups.

STUDY DESIGN

Mothers (n = 734) of preterm infants cared for >5 days in the NICU and participating in a Transition Home Program completed the Fragile Infant Parent Readiness Evaluation prior to discharge for perceptions of NICU staff support, infant well-being, maternal well-being (emotional readiness/competency), and maternal comfort (worry about infant). Mental health history and social risk factors were obtained. At 1 month postdischarge the Edinburgh Postnatal Depression Scale was administered. Group comparisons and logistic regression analyses were run to predict possible depression (Edinburgh Postnatal Depression Scale  ≥10).

RESULTS

Mothers of early, moderate, and late preterm infants reported similar rates of possible depression (20%, 22%, and 18%, respectively) 1 month after NICU discharge. History of mental health disorder, decreased perception of maternal well-being, decreased maternal comfort regarding infant, and decreased perception of family cohesion were associated with possible depression at 1 month postdischarge.

CONCLUSIONS

Mothers with a previous mental health disorder and experiencing negative perceptions of self and infant at NICU discharge were at increased risk for depressive symptomatology 1 month postdischarge regardless of infant gestational age. Comprehensive mental health assessment prior to discharge is essential to identify women at risk and provide appropriate referral.

Executive function is associated with social competence in preschool-aged children born preterm or full term

BACKGROUND

Executive function (EF), defined as higher-order cognitive processes used in planning and organizing actions and emotions, is often impaired in children born preterm. Few studies have assessed social competence, the processes and resources required to meet social demands and achieve social goals, in children born preterm. The relations between EF and social competence in preterm and full term preschoolers have not been well characterized.

AIMS

To characterize social competence and assess the relationship between EF and social competence in preschool-aged children born preterm or full term.

STUDY DESIGN

Cross-sectional study.

SUBJECTS

Study subjects had a history of preterm birth (≤34weeks of gestation) and birth weight <2500g (n=70). Controls were born full term (≥37weeks) (n=79).

OUTCOME MEASURES

Children completed a battery of EF tasks; a mean age-adjusted z-score for the battery was generated for each child. Parents rated child EF on one scale and child social competence on two standardized scales.

RESULTS

Compared to full term children, preterm children showed a lower mean EF battery z-score, poorer parent-rated EF, and poorer scores on the two social competence scales. In hierarchical multiple regression models, EF battery z-score and parent-rated EF made independent contributions to both measures of social competence. Preterm birth explained additional variance for one measure of social competence.

CONCLUSIONS

Standard assessment of EF skills and social competence in young preschool children, including children born preterm, may identify at-risk children for long-term social difficulties and may also provide targets for intervention.

Comportamento de Escolares Estratificados pelo Peso ao Nascer e Idade Gestacional

O peso e a idade gestacional são critérios relevantes para avaliação das condições de nascimento das crianças. O objetivo do presente estudo foi caracterizar e comparar o desempenho comportamental de uma coorte de crianças estratificada pelo peso ao nascer e pelo peso ao nascer em relação à idade gestacional. Avaliaram-se, aos 10/11 anos, 677 crianças por meio do Questionário de Capacidades e Dificuldades. Verificou-se, com significância estatística, os seguintes resultados: o grupo Baixo Peso apresentou mais sintomas emocionais que o grupo Peso Normal; o grupo Muito Baixo Peso mostrou mais hiperatividade em comparação aos outros; o grupo Pequeno para a Idade Gestacional apresentou mais dificuldades no escore total e mais sintomas emocionais em relação aos demais grupos. Concluiu-se que a estratificação por dois critérios permitiu a identificação de dificuldades específicas quanto ao desempenho comportamental.

Variables associated with cognitive, behavioral and emotional development: a cohort of schoolchildren

This study aimed to identify possible variables associated with cognitive, behavioral and emotional development in a cohort of school children, based on biological (sex, gestational age and birth weight) and socioeconomic variables (marital status, maternal and paternal education, occupation of head of household, socioeconomic status, and number of household members). We evaluated 790 children born in a cohort of Ribeirão Preto (SP), Brazil, with 10/11 years of age. The Raven Test was used for cognitive assessment and the Strengths and Difficulties Questionnaire was utilized for emotional and behavioral assessment. By means of multivariate logistic regression analysis (CI 95%) we found that: 1) low maternal schooling was associated with behavioral and emotional problems and poor cognitive function, 2) being female was considered as a protective factor against behavioral problems and 3) low birth weight and prematurity were not associated with the outcomes investigated.