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Patterns and Predictors of Neurodevelopmental Profiles in Very Preterm Children at Age 5 Years

Sat, March 23, 9:45 to 11:15am, Hilton Baltimore, Floor: Level 1, Johnson B

Integrative Statement

Introduction: Children born very preterm (VPT; <30 weeks gestation) are at increased risk of cognitive, language and motor delays, and attention deficit/hyperactivity (ADHD), anxiety, and autism spectrum (ASD) disorders compared to full-term (FT) children. Infant clinical factors and socio-economic status influence pathways to risk and resiliency among VPT children. However, the influence of other socio-environmental and family factors is less clear. In this study, we hypothesized that VPT children would be comprised of resilient and impaired subgroups. We also hypothesized that after accounting for clinical and sociodemographic factors; maternal psychosocial distress, family dysfunction, maternal IQ, and maternal and paternal ADHD and ASD symptoms would be associated with impairment.
Methods: As part of a longitudinal study, 85 VPT children were recruited from a level-III Neonatal Intensive Care Unit in a large pediatric hospital. A second group of 40 demographically-matched FT children were recruited from an adjacent maternity hospital and from the community. At age 5-years, all children were assessed on the Wechsler Preschool and Primary Scales of Intelligence-III, Clinical Evaluation of Language Fundamentals-Preschool 2, and the Movement Assessment Battery for Children-II. The Behavior Rating Inventory of Executive Function-Preschool, Conner’s ADHD Index, Child Behavior Checklist, and Social Responsiveness Scale-2 were completed by parents and teachers. These measures were analyzed using Latent Profile Analysis to determine latent neurodevelopmental and psychiatric profiles, which were then compared on infant, social, and family measures collected from birth to age 5-years. Measures of interest included infant clinical and social risk index scores; a maternal psychosocial distress index comprised of depression, anxiety, parenting stress, adverse life events, and social support; family dysfunction; maternal IQ; and parental ASD and ADHD symptoms. Multinomial logistic regression was used to determine predictors of latent profiles.
Results: The results of the LPA identified four latent profiles (p<.001, Figure 1). Profiles spanned a Resilient Group with no neurodevelopmental or psychiatric problems (47% VPT, 53% FT); a Psychiatric Group with prominent ADHD, ASD and anxiety symptoms (73% VPT, 27% FT), a teacher-identified Inattentive Group (93% VPT, 7% FT), and an At-Risk Group with moderately elevated neurodevelopmental and psychiatric problems (81% VPT, 19% FT, p<.001). Figure 2 shows that the Psychiatric Group had the highest rate of any clinical diagnoses (80%), followed by the At-Risk (40%) and Inattentive (36%) Groups. No diagnoses were observed in the Resilient Group (p<.001). Social and family factors associated with the Resilient Group included being raised in a two-parent household (p=.01), private health insurance (p=.05), higher maternal IQ (p=.001); and lower levels of family dysfunction (p=.007), maternal psychosocial distress (p<.001) and parental ASD and ADHD symptoms (p<.001). Among VPT children, infant clinical factors did not differentiate the groups (p>.05). Instead, varying levels of family dysfunction (p=.03) and maternal psychosocial distress (p=.02) were associated with risk and resiliency in VPT children.
Conclusions: VPT children are a heterogeneous group characterized by discrete patterns of neurodevelopmental and psychiatric impairments. Family dysfunction and maternal psychosocial distress are potentially modifiable factors that should be addressed as early as NICU admission to promote resiliency among VPT infants.

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