Page 56 - Sample Moderate prematurity, socioeconomic status, and neurodevelopment in early childhood

Chapter 5
ABSTRACT
Objective To determine the occurrence of emotional and behavioural problems (EBP) in moderate to late preterm-born (MLP) and full-term children with developmental delay.
Design Participants were recruited from thirteen randomly selected preventive child healthcare (PCH) centres in the Netherlands. We included 903 MLP children of 32-36 weeks’ gestation and 538 full-term controls, born between January 2002 and June 2003. Parents completed the Ages and Stages Questionnaire (ASQ) and Child Behavior Checklist (CBCL) shortly before the scheduled PCH visit at four years of age. In logistic regression analyses we used a composite measure of co- occurrence: ASQ total or domain score >2 SDs below the mean and a CBCL score >84th percentile on total problems, internalizing (emotional) or externalizing (behavioural) problems.
Results Among MLP children with abnormal ASQ total problems-scores, EBP were more prevalent than among full-term children, particularly regarding externalizing problems (34% vs. 24%). In MLP children, rates of EBP differed per developmental domain and were highest for domains problem-solving (36% had externalizing problems) and personal-social skills (39% had internalizing problems). The risk of any type of co-occurrence was higher for MLP than full-term children (OR 1.86; 95% CI 1.14-3.03). Independent risk factors for co-occurrence were male gender, low socioeconomic status, and young maternal age.
Conclusions Up to 39% of 4-year-old MLP children with developmental delay also have EBP. Given the low number of full-term controls with co-occurring problems, larger studies are needed to determine the independent contribution of moderate prematurity to co-occurrence, relative to other risk factors.
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