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Moderate prematurity associated with behavioral problems

Robin Wulffson MD's picture
moderate prematurity, behavioural problems, emotional development

UNIVERSITY OF GRONINGEN, THE NETHERLANDS - With today’s advanced medical technology, infants born moderately premature - between 32 and 36 weeks of gestation - have an excellent chance of survival. Once they catch up in weight with their full-term peers, their parents breathe a sigh of relief and anticipate a rosy future for their child.

However, according to a new study, children born moderately prematurely have more behavioral problems in their preschool years than do children who are born full-term. Marieke R. Potijk, MD and colleagues at the University of Groningen, the Netherlands published the results of their study online December 6 in the journal Archives of Disease in Childhood.

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The researchers found that moderately premature children demonstrated more internalizing and externalizing behaviors, more trouble sleeping, and other problems, including attention disorders, aggression, anxiety, and depression, than children born full-term. In addition, the emotional and behavioral outcomes of children born moderately prematurely were more pronounced in girls than in boys. This finding is interesting because of the fact that premature girls have a higher survival rate than premature boys.

The authors wrote: "Our results demonstrate that MP [moderately premature] children are more likely to already have behavioural and emotional problems before they enter school. Therefore, MP children could be a potential target group for the prevention of mental health problems, as behavioural and emotional problems in early childhood tend to persist in later childhood and adolescence."

Children born prematurely and at very low birth weight are known to have a higher risk for behavioral and mental problems. In this study, the investigators attempted to determine what impact birth just a few weeks too early might have. The study group was comprised of 995 moderately preterm children and 577 full-term children whose behavior and emotional development were assessed when the children were slightly younger than four years of age; the researchers used the Child Behavior Checklist (CBCL) for ages 1.5 to 5 years. Higher scores on the CBCL indicated worse outcomes. The children were part of the Longitudinal Preterm Outcome Project (Lollypop), a large, prospective study, which assessed the growth, development, and general health of children born prematurely. The researchers found that moderately preterm children had higher scores than their term peers on all measures. On the average, cumulative CBCL scores for preterm children were 4 points higher than those of their full-term peers.

The average difference on total problems was 4.04 points. The prevalence rates of externalizing, or the tendency to act out, were highest in boys (10.5%); internalizing problem behaviors were highest in girls (9.9%). The children born moderately prematurely were also almost twice as likely to have somatic (bodily) complaints, internalizing, externalizing, and total problems. The authors suggested that interventions at the time the children enter school might include extra support or specialized school services and psychological assistance. They added that their findings should be confirmed by additional studies, "as we were the first to assess the full range of behavioural and emotional problems in MP children just before they enter school."