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Published online December 14, 2009
PEDIATRICS Vol. 125 No. 1 January 2010, pp. e83-e89 (doi:10.1542/peds.2009-0634)
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ARTICLE

Biological and Environmental Predictors of Behavioral Sequelae in Children Born Preterm

Amy L. Conrad, PhDa, Lynn Richman, PhDb, Scott Lindgren, PhDb, Peg Nopoulos, MDa

a Department of Psychiatry Research, University of Iowa College of Medicine, Iowa City, Iowa
b Department of Pediatrics, University of Iowa Children's Hospital, Iowa City, Iowa

OBJECTIVE: By using behavioral outcome measures of children who were born preterm, we evaluated differences between children who were born at term and children who were born at extremely low (ELBW; <1000 g) and very low birth weights (VLBW; 1000–1499 g) and assessed the relationship of birth weight, socioeconomic status, and cognitive ability to behavioral outcome.

METHODS: We studied a total of 104 children (aged 7–16 years). Of these, 49 had a preterm birth (31 of ELBW and 18 of VLBW). The remaining 55 were healthy control subjects. Children were administered tests of cognitive ability. Parents and teachers completed behavioral assessments. Multivariate analyses of covariance assessed differences between children who were born at term and those who were born of ELBW and of VLBW on behavioral measures. Hierarchical linear regressions were used to assess relationships among biological (birth weight), environmental (socioeconomic status), intellectual, and behavioral variables.

RESULTS: Children who were born at term had fewer parent reports of hyperactivity/inattention and depression/anxiety symptoms than children of ELBW and VLBW. Teacher ratings were not significant between groups. Birth weight was consistently the strongest predictor of parent ratings of behavioral outcome, and intelligence level did not seem to mediate this relationship.

CONCLUSIONS: Negative behavioral sequelae of preterm birth remain significant in middle childhood and adolescence, although the contribution of multiple factors to neurobehavioral outcome is complex. Research to assess these relationships, integrated with anatomic and functional neuroimaging, is needed to advance knowledge and improve outcomes for children who are born preterm.

Key Words: prematurity • behavior • predictors

Abbreviations: ELBW—extremely low birth weight • VLBW—very low birth weight • SES—socioeconomic status • MANCOVA—multivariate analysis of covariance • GAI—General Ability Index • WISC—Wechsler Intelligence Scale for Children • PBS-30—Pediatric Behavior Scale–30

Accepted Jul 18, 2009.


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