Risk profiles of the preterm behavioral phenotype in children aged 3 to 18 years

Forever premature: Adults born preterm and their life challenges

BACKGROUND

Adults born preterm face greater social, cognitive, mental and physical challenges in adulthood than their full term born peers according to longitudinal studies. In contrast, little is known about the lived experiences of adults born preterm.

OBJECTIVE

The study investigates the lived experiences of adults born preterm across the life course and their views on health care support.

METHODS

A qualitative study of 21 participants completing semi structured interviews analyzed through content analysis.

RESULTS

Over half of adults born preterm report trauma and feeling of otherness since early childhood, high sensitivity to the environment, higher introversion/shyness and social or performance related anxiety. Over half reported that their parents were traumatized by the preterm birth and tried to compensate by overprotective parenting that, however, stifled them becoming independent. Over half experienced bullying victimization and many have continuing mental health problems. Overload by demands in school or work is a consistent theme that makes it hard to have the energy to socialize. Many received physical therapy in childhood and most had psychotherapy in adulthood. Many feel that health professionals trivialize the long-term effects of prematurity and most find support from their parents or peer network.

CONCLUSIONS

Prematurity has significantly shaped the life of adults born preterm. Greater awareness and recognition of the unique needs of this group are essential to provide adequate support. Existing services fail to address these needs highlighting an urgent demand for enhanced social and psychological services for educational and workplace settings.

White-matter controllability at birth predicts social engagement and language outcomes in toddlerhood

Social engagement and language are connected through early development. Alterations in their development can have a prolonged impact on children's lives. However, the role of white matter at birth in this ongoing connection is less well-known. Here, we investigate how white matter at birth jointly supports social engagement and language outcomes in 642 infants. We use edge-centric network control theory to quantify edge controllability, or the ability of white-matter connections to drive transitions between diverse brain states, at 1 month. Next, we used connectome-based predictive modeling (CPM) to predict the Quantitative Checklist for Autism in Toddlers (Q-CHAT) for social engagement risks and the Bayley Scales of Infant and Toddler Development (BSID-III) for language skills at 18 months from edge controllability. We created the social engagement network (SEN) to predict Q-CHAT scores and the language network (LAN) to predict BSID-III scores. The SEN and LAN were complex, spanning the whole brain. They also significantly overlapped in anatomy and generalized across measures. Controllability in the SEN at 1 month partially mediated associations between Q-CHAT and BSID-III language scores at 18 months. Further, controllability in the SEN significantly differed between term and preterm infants and predicted Q-CHAT scores in an external sample of preterm infants. Together, our results suggest that the intertwined nature of social engagement and language development is rooted in an infant's white-matter controllability.

Significance Statement

During infancy and toddlerhood, social engagement and language emerge together. Delays are often observed in both simultaneously. These interactions persist into later childhood, potentially affecting life quality. We reveal that the interplay between social engagement and language milestones in toddlerhood is rooted in the infant's structural connectivity, which may assist in early risk identification of developmental delays. Insights into the early brain foundations for emerging social engagement and language skills may open opportunities for individualized interventions to improve developmental outcomes.

Beyond average outcomes: A latent profile analysis of diverse developmental trajectories in preterm and early term-born children from the Adolescent Brain Cognitive Development study

Preterm birth poses a major public health challenge, with significant and heterogeneous developmental impacts. Latent profile analysis was applied to the National Institutes of Health Toolbox performance of 1891 healthy prematurely born children from the Adolescent Brain and Cognitive Development study (970 boys, 921 girls; 10.00 ± 0.61 years; 1.3% Asian, 13.7% Black, 17.5% Hispanic, 57.0% White, 10.4% Other). Three distinct neurocognitive profiles emerged: consistently performing above the norm (19.7%), mixed scores (41.0%), and consistently performing below the norm (39.3%). These profiles were associated with lasting cognitive, neural, behavioral, and academic differences. These findings underscore the importance of recognizing diverse developmental trajectories in prematurely born children, advocating for personalized diagnosis and intervention to enhance care strategies and long-term outcomes for this heterogeneous population.

Associations between maternal preconception and pregnancy adiposity and neuropsychiatric and behavioral outcomes in the offspring: A systematic review and meta-analysis

Maternal adiposity (overweight or obesity) has been associated with adverse perinatal outcomes, although the potential risks of long-term neuropsychiatric and behavioral outcomes in the offspring remain unclear. Using the PRISMA guidelines, we searched PubMed, EMBASE, Scopus, and Web of Science to identify studies on maternal adiposity and offspring neuropsychiatric outcomes. Inverse variance-weighted random-effects meta-analyses were used to pool effect estimates with 95 % confidence intervals (95 % CIs) from adjusted odds ratios (OR) and hazard ratios (HR). Estimates were computed separately for preconception and pregnancy maternal overweight and obesity, with outcomes stratified by the type of neuropsychiatric outcome. In our meta-analyses of 42 epidemiological studies involving 3,680,937 mother-offspring pairs, we found increased risks of ADHD [OR=1.57, 95 % CI: 1.42-1.74], autism spectrum disorder [OR=1.42, 95 % CI: 1.22-1.65], conduct disorder [OR=1.16, 95 % CI: 1.00-1.35], Psychotic disorder [HR=1.61, 95 % CI: 1.41-1.83], externalizing behaviors [OR=1.30, 95 % CI: 1.07-1.56] and peer relationship problems [OR=1.25, 95 % CI: 1.04-1.27] in the offspring of preconception obese mothers. Similar increased risks were found in the offspring of preconception overweight mothers and those exposed to maternal adiposity during pregnancy. However, no association was found with offspring mood, anxiety, personality, eating, sleep disorders or prosocial problems. Preconception weight management may mitigate such adverse effects in the offspring.

Optimizing trajectories of social adaptive competencies after extreme prematurity during the first 1000 days

Over 75% of surviving extremely preterm infants do not have major neurodevelopmental disabilities; however, more than half face difficulties with communication, coordination, attention, learning, social, and executive function abilities. These "minor" challenges can have a negative impact on educational and social outcomes, resulting in physical, behavioral, and social health problems in adulthood. We will review assessment tools for social-emotional and adaptive functional skills in early childhood as these determine family and early childhood supports. We highlight bronchopulmonary dysplasia as an example of the critical intersections of parental wellbeing, medical and developmental adaptive trajectories in infancy and early childhood, and partnerships between child neurologists and community medical and developmental professionals. We examine studies of engaging parents to promote developmental trajectories, with a focus on supporting parent-child interactions that underlie communication, social-adaptive behaviors, and learning in the first 1000 days of life. Recommendations for neurodevelopmental surveillance and screening of extremely preterm infants can also be applied to infants with other risk factors for altered neurodevelopment.