Perinatal factors have long been implicated in the genesis of psychiatric disorders, most notably in schizophrenia, but the role such factors play in the causal pathway is less well understood. For a long time, a range of biological insults, including preterm birth and LBW, were considered nonspecific triggers for later disorders (1). More recently, epidemiologic studies in the general population have identified significant inverse incremental associations with birthweight and/or GA at birth: the risk and prevalence of psychiatric morbidity increase as birthweight and GA decrease (2). Although these associations are not confined to those with very LBW (VLBW; birthweight ≤1500 g) or very preterm birth (VPT; <32 wk gestation), the risk is greatest for these groups (2,3). Preterm birth and LBW have also been identified as risk factors for specific psychiatric disorders, namely emotional disorders (2–5), attention deficit/hyperactivity disorders (ADHD) (6), and autism spectrum disorders (ASD) (7–10).Comorbidities Associated With Prematurity Essay
The casual pathway to these disorders must be interpreted in the context of the known neurologic sequelae of preterm birth, namely focal brain injury and altered brain development (11). These are manifest in the relationship between immaturity and CP (12) and low intelligent quotient (IQ) (13,14)/learning difficulties (15), respectively. The prevalence of impaired outcomes rises more steeply as GA falls below 32 wk and thus one might predict that psychiatric morbidity would be most prevalent in such populations. Where birthweight has been used to define populations, there may be differences in outcomes stemming from the excess of children born after fetal growth restriction, which have independent effects on psychiatric morbidity (16).
Several studies have now followed the progress of very immature cohorts born in the 1980s and 1990s through to adolescence and adult life, and have sought to define the full spectrum of impairment, including psychiatric disorders. We place emphasis on population-based studies, particularly for cohorts born in the 1990s, because these reflect the most contemporaneous outcomes relevant to current public health concerns. In this article, we review clinical studies of outcomes in middle childhood and beyond and present an overview of behavioral and psychiatric morbidity in relation to neurodevelopmental correlates and early predictors of disorders in preterm populations.Comorbidities Associated With Prematurity Essay
Prevalence and Profile of Behavior Problems
The majority of studies investigating morbidity for preterm (<37 wk)/LBW (<2500 g) cohorts have used behavioral screening questionnaires, such as the widely used Child Behavior Checklist (CBCL) (17). These provide cost- and time-efficient measures for large-scale use. Studies using screening questionnaires have shown that there is a significant excess of behavior problems in most preterm/LBW cohorts (18), and prevalence estimates range from 19 to 40% for LBW (19–22), 13 to 46% for VPT/VLBW (16,23–26), and 19 to 32% for extremely preterm (EPT: <26 wk)/extremely LBW (ELBW: ≤1000 g) (27–30) children. There is less consensus for children born moderate to late preterm (32–36 wk of gestation); some report an excess of behavior problems (31,32), whereas others report no significant difference from term peers (33). A GA-related gradient in outcomes is supported by a number of studies in which the prevalence of behavior problems was greater in those born at lower gestations or with LBW (26,34).Comorbidities Associated With Prematurity Essay
Variable findings are reported regarding the risk for internalizing and externalizing problems. In a meta-analysis of 16 case-control studies of school-aged VPT/VLBW children published in 1980–2001, 9 of 13 studies reported an increase in internalizing symptoms and 9 of 12 in externalizing symptoms (18). In a later meta-analysis of nine case-control studies of VPT (here defined as birth <34 wk)/VLBW children published between 1998 and 2008, parents rated their children as having more internalizing problems but combined effect sizes for parent- and teacher-rated externalizing problems were nonsignificant (35). More recent studies continue to report conflicting results regarding the risk for internalizing (28,31,34) and externalizing problems (23). Given the inverse relationship with maturity, some of this difference may be due simply to heterogeneity in population definitions.Comorbidities Associated With Prematurity Essay
There is greater consensus at the narrowband level in terms of behavioral profiles identified. Hille et al. (36) report cross-cultural outcomes in four population-based ELBW cohorts born in 1977–1987 and assessed using the CBCL. Externalizing scores were not elevated in any cohort and internalizing scores were inc
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