Abstract
ObjectiveTo assess which factors, including maternal, lifestyle, pregnancy- and delivery-related, fetal and neonatal factors adjusted for socio-economic status, are related to emotional and behavioral problems in moderately-late preterm born children (MLPs; gestational age 32.0–35.9 weeks) at 4 years of age. MLPs are at greater risk of emotional and behavioral problems than full-term born children. Especially for MLPs, knowledge about factors that increase or decrease the risk of emotional and behavioral problems is scarce.Design and settingWe assessed emotional and behavioral problems in 809 MLPs between ages 41 and 49 months from the prospective community-based Longitudinal Preterm Outcome Project (LOLLIPOP), using the parent-reported Child Behavior Checklist (CBCL). We collected potential risk factors from hospital records and parental questionnaires. Univariable and multiple logistic regression analyses were applied.Main outcome measures(Sub)clinical CBCL scores.ResultsPerinatal infection increased the risk of CBCL total problem scores with an OR 2.22 (p<0.01). Perinatal infection, maternal smoking, and male gender increased the risk of CBCL externalizing problem scores with ORs between 1.64 and 2.46 (all p<0.05). Multiple birth decreased the risk of CBCL internalizing problem scores with an OR 0.63 (p<0.05).ConclusionsRisk factors for behavioral problems in MLPs are male gender, perinatal infection and maternal smoking, the latter two being potentially modifiable. Multiple birth is a protective factor for emotional problems in MLPs. These results suggest potential factors for targeting preventive intervention in MLPs, comprising the large majority of all preterm born children.
Highlights
Moderately-late preterm born children (MLPs, gestational age (GA) 32.0–35.9 weeks, 85% of all preterm born children [1]) are at a 1.5 to 2.5-fold increased risk of emotional and behavioral problems compared to full-term born children (FTs, GA 38.0–41.9 weeks) [2,3,4]
Perinatal infection increased the risk of Child Behavior Checklist (CBCL) total problem scores with an Odds ratios (OR) 2.22 (p
Maternal smoking, and male gender increased the risk of CBCL externalizing problem scores with ORs between 1.64 and 2.46
Summary
Moderately-late preterm born children (MLPs, gestational age (GA) 32.0–35.9 weeks, 85% of all preterm born children [1]) are at a 1.5 to 2.5-fold increased risk of emotional and behavioral problems compared to full-term born children (FTs, GA 38.0–41.9 weeks) [2,3,4]. MLPs born healthy at birth demonstrate more emotional and behavioral problems than FTs treated at the neonatal intensive care unit (NICU) after birth [3]. These emotional and behavioral problems frequently persist in later life [5]. Poorer longitudinal postnatal growth was not found to be associated with emotional and behavioral problems at seven years of age [13], and a British study from 2001 [7] found several factors increasing the risk of school problems in MLPs, such as male sex and postnatal discharge from the special baby care unit beyond 36 weeks postmenstrual age. In a study based on our own cohort, SES was found to have a stronger effect on the development of emotional and behavioral problems in children with a lower GA [11]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
