Behavior Profiles at 2 Years for Children Born Extremely Preterm with Bronchopulmonary Dysplasia

Jane E Brumbaugh,Avroy A Fanaroff,Elizabeth T Heyne,Richard A Polin,Jacky R Walker,Cheri Gauldin,Deanna Maffett,Janice Bernhardt,Edward F Bell,Girija Natarajan,Sudarshan R Jadcherla,Sandra Wuertz,Allison G Dempsey,Dan L Ellsbury,Robin K Ohls,Karie Bird,Namasivayam Ambalavanan,Conra Backstrom Lacy,Uday Devaskar,Mary E Johnson,Christine G Butler,Patricia L Ashley,Nancy A Miller,Teresa Chanlaw,Margaret Crawford,Bonnie E Stephens,Nehal A Parikh,Ivan D Frantz,Cynthia Spencer,Anne Marie Reynolds,Elaine Romano,Margarita Jiminez,Gloria V Smikle,Ellen Nylen,Carol Hartenberger,Kirstin J Bailey,Joan Merzbach,Barbara Alksninis,Elisabeth C Mcgowan,Andrew W Palmquist,Barbara Schmidt,David P Carlton,John M Fiascone,Karen Wynn,Haresh Kirpalani,Tracy L Tud,Julie Arldt-Mcalister,Colleen Mackie,Shirley S Cosby,Susan Gunn,David Kaegi,Lucy Smiley,Betty R Vohr,Brenda B Poindexter,Rosemary D Higgins,Richard V Rector,Ronald N Goldberg,Susan R Hintz,Dennis Wallace,Alicia Guzman,Salathiel Kendrick-Allwood,Diane I Bottcher,Cait Fallone,Casey E Krueger,Roy J Heyne,Monika Bhola,Teresa L Gratton,Marie G Gantz,Angela Leon-Hernandez,Katrina Burson,Wade Rich,Patricia Cervone,Patricia Luzader,Gulgun Yalcinkaya,Leif D Nelin,Manndi C Loertscher,Richard A Ehrenkranz,Lynne C Huffman,Valerie Y Chock,Anne Furey,Teresa M Leach,Scott F Grey,Maureen Mulligan Larossa,Emilee Little,Waldemar A Carlo,C Michael Cotten,Julianne Hunn,Jon E Tyson,Mike Steffen,Pollieanna Sepulveda,Karen Zanetti,Monika Bajaj,Rosemary L Jensen,David Leblond,Marsha Gerdes,Diana M Vasil,Janell Fuller,Yvonne E Vaucher,Kristin M Zaterka-Baxter,Nicholas H St John,Aasma S Chaudhary,Sarah Winter,Jenna Gabrio,Sheena L Carter,Hali E Weiss,Claire A Goeke,Joanne Finkle,Andrea M Knoll,Kurt Schibler,Sally S Adams,David K Stevenson,Jennifer O Elmont,Earl Maxson,Christine A Fortney,Radmila West,Ronnie Guillet,Roger G Faix,Shawna Rodgers,Carmena Bishop,Kimberlee Weaver-Lewis,Maria Elena Deanda,Rebecca Bara,Gail E Besner,Seetha Shankaran,Martin Keszler,Stephanie Wilson Archer,Lara Pavageau,Janice Wereszczak,Elizabeth N Reichert,Carmen Garcia,Sally Whitley,Gennie Bose,Sheila Greisman,Sara C Martin,Stephen D Kicklighter,Eugenia K Pallotto,Elizabeth Roth,Megan Broadbent,Ellen C Hale,Abbot R Laptook,Sandra Grimes,Bradley A Yoder,Mary Rowan,Kimberly Yolton,Myra H Wyckoff,Clarence Demetrio,Barbara Bentley,Mark J Sheffield,Meena Garg,Lijun Chen,Monica Konstantino,Trisha Marchant,Linda J Reubens,Elizabeth Kuan,Shawna Baker,Isabell B Purdy,Matthew A Rysavy,Deanne E Wilson-Costello,Marian M Adams,Mariana Baserga,Kristin Kirker,Patti L Pierce Tate,Tarah T Colaizy,Martha G Fuller,William E Truog,Andrea F Duncan,Soraya Abbasi,Melinda S Proud,Athina Pappas,Ashley Williams,Sara B Demauro,John M Dagle,Vivien A Phillips,Stephanie Guilford,Karen A Osborne,Bonnie S Siner,Dianne E Herron,Carrie A Rau,Allison Knutson,Beena G Sood,Martha Carlson,Hallam Hurt,Michael G Sacilowski,Sanjay Chawla,Kathryn D Woodbury,Howard W Kilbride,Michele C Walsh,Ann Marie Scorsone,Osman Farooq,Monica V Collins,Jennifer J Jensen,Jonathan M Klein,Pablo J Sánchez,Luc P Brion,Abbey C Hines,Georgia E Mcdavid,Anne M Debattista,Patricia W Evans,Cathy Twell Boatman,Krisa P Van Meurs,Dara M Cucinotta,Kelley Yost,Magdy Ismael,Megan M Henning,Stephen D Minton,Heather L Taylor,Elisa Vieira,Chelsey Elenkiwich,Nancy S Newman,Stephanie A Wiggins,Cathy Grisby,Toni Mancini,Susan T Schaefer,Kristi L Watterberg,Beth Earhart,Matthew M Laughon,Ana K Brussa,Kathleen A Kennedy,Ginger Rhodes-Ryan,Susan Christensen,Angelita M Hensman,Victoria E Watson,Kathy Johnson,Sandra Sundquist Beauman,Frances Eubanks,Karen Martin,Michael S Caplan,Ricki F Goldstein,Brandy Davis,Anne Holmes,Janet Taft,Sharon L Wright,Kathy Arnell,Jill Burnett,John Barks,Kathryn E Gustafson,Janice John,Gregory M Sokol,Carolyn M Petrie Huitema,Mendi L Schmelzel,Holly I.M Wadkins,Diane F White,Linda A Madden,Diane Warner,Heidi M Harmon,Barbara J Stoll,Rachel Geller,Neil N Finer,Abhik Das,Cecelia E Sibley,Gary J Myers,William Zorn,Lizette E Lee,Fred J Biasini,Jean Lowe ,Satyanarayana Lakshminrusimha ,Mary Lenore Keszler ,Brenda Mackinnon ,Saba Siddiki ,Patrick Jones ,Myriam Peralta‐Carcelen ,Dilys M Parry ,Mary Christensen ,Robert Burke ,Maynard Rasmussen ,Shazia Bhombal ,Jamie Newman ,Michelle Baack ,Carl T D’angio ,Michelle Hartley-Mcandrew ,Carl Bose ,Lynn Wineski ,Sandra M Brown ,Stephanie L Merhar ,William Malcolm ,Yvonne Loggins ,Ira Adams‐Chapman ,Harriet Friedman ,Judy Bernbaum ,Mary Hanson ,Jo Ann Poulsen ,Mark Lillie ,Michelle Ball ,Carla Bann ,Harris C Jacobs ,John W Logan ,Laura A Goldston ,Tara L Dupont ,L.a Papile ,Kimberley Fisher ,Allison H Payne ,Diane Prinzing ,Jeanette O’donnell Auman ,Maria Magdalena Leon ,Karen Johnson ,Daniel K Sperry ,Laurie Hogden

doi:10.1016/j.jpeds.2019.12.028

Abstract

To characterize behavior of 2-year-old children based on the severity of bronchopulmonary dysplasia (BPD). We studied children born at 22-26weeks of gestation and assessed at 22-26months of corrected age with the Child Behavior Checklist (CBCL). BPD was classified by the level of respiratory support at 36weeks of postmenstrual age. CBCL syndrome scales were the primary outcomes. The relationship between BPD grade and behavior was evaluated, adjusting for perinatal confounders. Mediation analysis was performed to evaluate whether cognitive, language, or motor skills mediated the effect of BPD grade on behavior. Of 2310 children, 1208 (52%) had no BPD, 806 (35%) had grade 1 BPD, 177 (8%) had grade 2 BPD, and 119 (5%) had grade 3 BPD. Withdrawn behavior (P<.001) and pervasive developmental problems (P<.001) increased with worsening BPD grade. Sleep problems (P=.008) and aggressive behavior (P=.023) decreased with worsening BPD grade. Children with grade 3 BPD scored 2 points worse for withdrawn behavior and pervasive developmental problems and 2 points better for externalizing problems, sleep problems, and aggressive behavior than children without BPD. Cognitive, language, and motor skills mediated the effect of BPD grade on the attention problems, emotionally reactive, somatic complaints, and withdrawn CBCL syndrome scales (P values<.05). BPD grade was associated with increased risk of withdrawn behavior and pervasive developmental problems but with decreased risk of sleep problems and aggressive behavior. The relationship between BPD and behavior is complex. Cognitive, language, and motor skills mediate the effects of BPD grade on some problem behaviors.

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