Enhancing the Follow-up Assessment of Very Preterm Children with Regard to 5-Year IQ Considering Socioeconomic Status

Abstract

Background Specifying peri- and postnatal factors in children born very preterm (VPT) that affect later outcome helps to improve long-term treatment.

Aim To enhance the predictability of 5-year cognitive outcome by perinatal, 2-year developmental and socio-economic data. Subjects and outcome measures: 92 VPT infants, born 2007–2009, gestational age<32 weeks and/or birthweight of 1500 g, were assessed longitudinally including basic neonatal, socio-economic (SES), 2-year Mental Developmental Index (MDI, Bayley Scales II), 5-year Mental Processing Composite (MPC, Kaufman-Assessment Battery for Children), and Language Screening for Preschoolers data. 5-year infants born VPT were compared to 34 term controls.

Results The IQ of 5-year infants born VPT was 10 points lower than that of term controls and influenced independently by preterm birth and SES. MDI, SES, birth weight and birth complications explained 48% of the variance of the MPC. The MDI proved highly predictive (r=0.6, R2=36%) for MPC but tended to underestimate the cognitive outcome. A total of 61% of the 2-year infants born VPT were already correctly classified (specificity of .93, sensitivity of .54). CHAID decision tree technique identified SES as decisive for the outcome for infants born VPT with medium MDI results (76–91): They benefit from effects associated to a higher SES, while those with a poor MDI outcome and a birth weight≤890 g do not.

Conclusion Developmental follow-up of preterm children enhances the quality of prognosis and later outcome when differentially considering perinatal risks and SES.

Zusammenfassung

Hintergrund Spezifisches Identifizieren peri- und postnataler Faktoren verbessert die langfristige Behandlung sehr frühgeborener (VPT) Kinder und damit ihre Entwicklungschancen.

Ziel Die kognitive Entwicklung 5-jähriger VPT Kinder auf Basis von perinatalen, sozioökonomischen und entwicklungsrelevanten 2-Jahres-Daten optimal vorhersagen. Patienten und Methoden: 92 sehr Frühgeborene, geboren 2007–2009,<32 SSW bzw.<1500 g wurden längsschnittlich untersucht anhand von neonatalen Daten, sozioökonomischem Status (SES), 2-Jahres Mental Developmental Index (MDI, Bayley Scales II), 5-Jahres IQ (MPC, K-ABC) und des Sprachscreenings für Vorschulkinder. Die 5-jährigen VPT Kinder wurden mit 34 gleichaltrigen Reifgeborenen verglichen.

Ergebnisse 5-jährige VPT Kinder hatten einen 10 Punkte niedrigeren IQ als Reifgeborene, separat beeinflusst durch die Faktoren Frühgeburt und SES. MDI; SES, Geburtsgewicht und -komplikationen erklärten 48% der Varianz des MPC. Der MDI erwies sich als starker Prädiktor (r=0.6, R2=36%), 61% der Frühgeborenen wurden bereits mit 2 Jahren richtig eingestuft (Spezifität .93, Sensitivität .54). Ein CHAID Entscheidungsbaum identifizierte den SES als entscheidende Variable bei mittlerem MDI (76–91). Diese VPT Kinder profitieren von einem höheren SES; jene mit schlechtem MDI und einem Geburtsgewicht ≤ 890 g tun dies nicht.

Schlussfolgerung Die differenzierte Berücksichtigung von perinatalen Risikofaktoren und SES verbessert die entwicklungsdiagnostische Nachsorge sehr frühgeborener Kinder in der Qualität der Prognose und damit ein besseres späteres Outcome.

Key words

very preterm - socioeconomic status - birthweight - prediction - cognitive

Schlüsselwörter

Sehr Frühgeborene - Sozioökonomischer Status - Geburtsgewicht - Vorhersage - Kognition

Publication History

Received: 15 July 2021

Accepted after revision: 16 May 2022

Article published online:
18 August 2022

• References

• 1 Shah DK, Doyle LW, Anderson PJ. et al. Adverse neurodevelopment in preterm infants with postnatal sepsis or necrotizing enterocolitis is mediated by white matter abnormalities on magnetic resonance imaging at term. J Pediatr 2008; 153: 170-175
• 2 Volpe JJ. Brain injury in premature infants: a complex amalgam of destructive and developmental disturbances. Lancet Neurol 2009; 8: 110-124
• 3 van Vliet EO, de Kieviet JF, Oosterlaan J. et al. Perinatal infections and neurodevelopmental outcome in very preterm and very low-birth-weight infants: a meta-analysis. JAMA Pediatr 2013; 67: 662-668
• 4 Short EJ, Kirchner HL, Asaad GR. et al. Developmental sequelae in preterm infants having a diagnosis of bronchopulmonary dysplasia: analysis using a severity-based classification system. Arch Pediatr Adolesc Med 2007; 161: 1082-1087
• 5 Turkheimer E, Haley A, Waldron M. et al. Socioeconomic status modifies heritability of IQ in young children. Psychol Sci 2003; 14: 623-628
• 6 Plomin R, Spinath FM. Genetics and general cognititve ability (g). Mol Psychiatry 2002; 6: 169-176
• 7 Wong HS, Edwards P. Nature or nurture: a systematic review of the effect of socio-economic status on the developmental and cognitive outcomes of children born preterm. Intelligence 2013; 17: 1689-1700
• 8 Navarro-Carrillo G, Alonso-Ferres M, Moya M. et al. Socioeconomic status and psychological well-being: revisiting the role of subjective socioeconomic status. Front Psychol 2020; 11: 1303
• 9 Bradley RH, Corwyn RF. Socioeconomic status and child development. Annu Rev Psychol 2002; 53: 371-399
• 10 Plomin R, Deary IJ. Genetics and intelligence differences: five special findings. Mol Psychiatry 2015; 20: 98-108
• 11 Chiavarini M, Bartolucci F, Gili A. et al. Effects of individual and social factors on preterm birth and low birth weight: empirical evidence from regional data in Italy. Int J Public Health 2012; 57: 261-268
• 12 Altenhöner T, Köhler M, Philippi M. The relevance of maternal socioeconomic characteristics for low birth weight – a case-control study. Geburtshilfe Frauenheilkd 2016; 76: 248-254
• 13 Benavente-Fernández I, Synnes A, Grunau RE. et al. Association of socioeconomic status and brain injury with neurodevelopmental outcomes of very preterm children. JAMA Netw Open 2019; 2: e192914-e192914
• 14 Lidzba K, Rodemann S, Goelz R. et al. Growth in very preterm children: Head growth after discharge is the best independent predictor for cognitive outcome. Early Hum Dev 2016; 113: 183-188
• 15 Wolke D, Schulz J, Meyer R. Entwicklungslangzeitfolgen bei ehemaligen, sehr unreifen Frühgeborenen: Bayerische Entwicklungsstudie. Monatsschr Kinderheilkd 2001; 149: 53-61
• 16 Patrianakos-Hoobler AI, Msall ME, Huo D. et al. Predicting school readiness from neurodevelopmental assessments at age 2 years after respiratory distress syndrome in infants born preterm. Dev Med Child Neurol 2010; 52: 379-385
• 17 Voss W, Jungmann T, Wachtendorf M. et al. Long-term cognitive outcomes of extremely low-birth-weight infants: the influence of maternal educational background. Acta Paediatr 2012; 101: 569-573
• 18 Hering T, Schlüter C, Wahl G. et al. Sozialstatus, Frühgeburtlichkeit und Entwicklungsstand von Kindern in Sachsen-Anhalt. Prävention und Gesundheitsförderung 2014; 9: 69-79
• 19 Johnson S. Cognitive and behavioural outcomes following very preterm birth. Semin Fetal Neonatal Med 2007; 12: 363-373
• 20 Reuner G, Rosenkranz J, Pietz J. et al. Bayley scales of infant development-II, deutsche Version. 2., korrigierte Auflage. Frankfurt: Pearson Assessment; 2008
• 21 Wood NS, Marlow N, Costeloe K. et al. Study Group for the EPICure Study. Neurologic and developmental disability after extremely preterm birth. N Engl J Med 2000; 343: 378-384
• 22 Procianoy RS, Koch MS, Silveira RC. Neurodevelopmental outcome of appropriate and small for gestational age very low birth weight infants. J Child Neurol 2009; 24: 788-794
• 23 Vohr BR, Stephens BE, Higgins RD. et al. Are outcomes of extremely preterm infants improving? Impact of Bayley assessment on outcomes. J Pediatr 2012; 161: 222-228
• 24 Hack M, Wilson-Costello D, Friedman H. et al. Neurodevelopment and predictors of outcomes of children with birth weights of less than 1000 g: 1992–1995. Arch Pediatr Adolesc Med 2000; 154: 725-731
• 25 Reuner G, Rosenkranz J. Bayley scales of infant development-III, deutsche Version. Frankfurt: Pearson Assessment; 2014
• 26 Breemann LD, Jaekel J, Baumann N. et al. Preterm cognitive function into adulthood. Pediatrics 2015; 136: 415-423
• 27 Twilhaar ES, Wade RM, de Kieviet JF. et al. Cognitive outcomes of children born extremely or very preterm since the 1990s and associated risk factors: a meta-analysis and meta-regression. JAMA pediatr 2018; 172: 361-367
• 28 Allotey J, Zamora J, Cheong-See F. et al. Cognitive, motor, behavioural and academic performances of children born preterm: a meta-analysis and systematic review involving 64061 children. BJOG 2018; 125: 16-25
• 29 Anderson P, Doyle LW. (Victorian Infant Collaborative Study Group). Neurobehavioral outcomes of school-age children born extremely low birth weight or very preterm in the 1990s. JAMA 2003; 289: 3264-3272
• 30 Kiese-Himmel C. Rezeptive und produktive Sprachentwicklungsleistungen frühgeborener Kinder im Alter von zwei Jahren. Z Entwickl Padagogis 2005; 37: 27-35
• 31 Barre N, Morgan A, Doyle LW. et al. Language abilities in children who were very preterm and/or very low birth weight: a meta-analysis. J Pediatr 2011; 158: 766-774
• 32 Franken MJP, Weisglas-Kuperus N. Language functions in preterm-born children: a systematic review and meta-analysis. Pediatrics 2012; 129: 745-754
• 33 Lowe JR, Erickson SJ, Schrader R. et al. Comparison of the Bayley II Mental Developmental Index and the Bayley III Cognitive Scale: are we measuring the same thing?. Acta Paediatr 2012; 101: e55-e58
• 34 Dos Santos ESL, de Kieviet JF, Königs M. et al. Predictive value of the Bayley Scales of Infant Development on development of very preterm/very low birth weight children: a meta-analysis. Early Hum Dev 2013; 89: 487-496
• 35 Potharst ES, Houtzager BA, van Sonderen LA. et al. Prediction of cognitive abilities at the age of 5 years using developmental follow-up assessments at the age of 2 and 3 years in very preterm children. Dev Med Child Neurol 2002; 54: 240-246
• 36 Munck P, Niemi P, Lapinleimu H. et al. Stability of cognitive outcome from 2 to 5 years of age in very low birth weight children. Pediatrics 2012; 129: 503-508
• 37 Sharp M, DeMauro SB. Counterbalanced comparison of the BSID-II and Bayley-III at eighteen to twenty-two months corrected age. J Dev Behav Pediatr 2017; 38: 322-329
• 38 Anderson PJ, De Luca CR, Hutchinson E. et al. Underestimation of developmental delay by the new Bayley-III Scale. Arch Pediatr Adolesc Med 2010; 164: 352-356
• 39 Hack M, Taylor HG, Drotar D. et al. Poor predictive validity of Bayley scales of infant development for cognitive function of extremely low birth weight children at school age. Pediatrics 2005; 116: 333-341
• 40 Reuner G, Pietz J. Entwicklungsdiagnostik im Säuglings- und Kleinkindalter. Monatsschr Kinderheilkd 2006; 154: 305-313
• 41 Johnson S, Moore T, Marlow N. Using the Bayley-III to assess neurodevelopmental delay: which cut-off should be used?. Pediatr Res 2014; 75: 670-674
• 42 Reuner G, Fields AC, Wittke A. et al. Comparison of the developmental tests Bayley-III and Bayley-II in 7-month-old infants born preterm. Eur J Pediatr 2013; 172: 393-400
• 43 Bhutta A, Cleves M, Casey P. et al. Cognitive and behavioral outcomes of school-aged children who were born preterm. A meta-analysis. JAMA 2002; 288: 728-737
• 44 Wolke D, Meyer R. Cognitive status, language attainment and pre-reading skills of 6 year-old very preterm children and their peers: The Bavarian Longitudinal Study. Dev Med Child Neurol 1999; 41: 94-109
• 45 Böhm A, Elsäßer G, Lüdecke K. Der Brandenburger Sozialindex: ein Werkzeug für die Gesundheits- und Sozialberichterstattung auf Landes- und kommunaler Ebene. Gesundheitswesen 2007; 68: 555-559
• 46 Lange M, Kamtsiuris P, Lange C. et al. Messung soziodemographischer Merkmale im Kinder-und Jugendgesundheitssurvey (KiGGS) und ihre Bedeutung am Beispiel der Einschätzung des allgemeinen Gesundheitszustands. Bundesgesundheitsblatt-Gesundheitsforschung-Gesundheitsschutz 2007; 50: 578-589
• 47 Suchodoletz WV, Sachse S, Kademann S. et al. Früherkennung von Sprachentwicklungsstörungen. Der SBE-2-KT und SBE-3-KT für zwei- bzw. dreijährige Kinder. Stuttgart: Kohlhammer; 2012
• 48 Melchers P, Preuß U. Kaufman Assessment Battery for Children, deutsche Version (K-ABC). Frankfurt: Pearsson Assessment; 2009
• 49 Grimm H. Sprachscreening für das Vorschulalter (SSV). Kurzform SETK 3–5. Göttingen: Hogrefe; 2003
• 50 Lemon SC, Roy J, Clark MA. et al. Classification and regression tree analysis in public health: methodological review and comparison with logistic regression. Ann Behav Med 2003; 26: 172-181
• 51 Wolke D, Samara M, Bracewell M. et al. Specific language difficulties and school achievement in children born at twenty five weeks of gestation or less. J Pediatr 2008; 152: 256-262
• 52 Wild K, Betancourt LM, Brodsky NL. et al. The effect of socioeconomic status on the language outcome of preterm infants at toddler age. Early Hum Dev 2013; 89: 743-746
• 53 Foster-Cohen SH, Friesen MD, Champion PR. et al. High prevalence/low severity language delay in preschool children born very preterm. J Dev Behav Pediatr 2010; 31: 658-667
• 54 Voss W, Hobbiebrunken E, Ungermann U. et al. Entwicklung extrem unreifer Frühgeborener. Dtsch Arztebl Int 2016; 113: 871-878
• 55 Orton J, Spittle A, Anderson P. et al. Do early intervention programmes improve cognitive and motor outcomes for preterm infants after discharge? A systematic review. Dev Med Cild Neurol 2009; 51: 851-859
• 56 Woodward LJ, Clark CA, Bora S. et al. Neonatal white matter abnormalities an important predictor of neurocognitive outcome for very preterm children. PloS one 2012; 7: e51879
• 57 Nosarti C, Giouroukou E, Healy E. et al. Grey and white matter distribution in very preterm adolescents mediates neurodevelopmental outcome. Brain 2007; 131: 205-217
• 58 Dodson CK, Travis KE, Ben-Shachar M. et al. White matter microstructure of 6-year old children born preterm and full term. Neuroimage 2017; 16: 268-275
• 59 Guo G, Mullan-Harris KM. The mechanisms mediating the effects of poverty on children’s intellectual development. Demography 2000; 37: 431-437
• 60 Sirin SR. Socioeconomic status and academic achievement: a meta-analytic review of research. Rev Educ Res 2005; 75: 417-453
• 61 Hack M, Klein N, Taylor H. Longterm developmental outcoms of low birthweight infants. Future Child 1995; 5: 176-196
• 62 Guralnick MJ. Preventive interventions for preterm children: effectiveness and developmental mechanisms. J Dev Behav Pediatr 2012; 33: 352-364
• 63 Ravn IH, Smith L, Lindemann R. et al. Effect of early intervention on social interaction between mothers and preterm infants at 12 months of age: a randomized controlled trial. Infant Behav Dev 2011; 34: 215-225
• 64 Schmidt CL, Lawson KR. Caregiver attention-focusing and children’s attention-sharing behaviours as predictors of later verbal IQ in very low birthweight children. J Child Lang 2002; 29: 3-22
• 65 Milgrom J, Newnham C, Anderson PJ. et al. Early sensitivity training of parents of preterm infants: impact on the developing brain. Pediatr Res 2010; 67: 330-335
• 66 Hill JL, Brooks-Gunn J, Waldfogel J. Sustained effects of high participation in an early intervention for low-birth-weight premature infants. Dev Psych 2003; 39: 730-744
• 67 Schäfer N, Karutz H, Schenk O. Die Notwendigkeit der psychosozialen Begleitung von Eltern in der Neonatologie. Z Geburtshilfe Neonatol 2017; 221: 217-225
• 68 Marlow N, Wolke D, Bracewell M. et al. Neurologic and developmental disability at six years of age after extremely preterm birth. N Engl J Med 2005; 352: 9-19
• 69 Larroque B, Ancel PY, Marret S. et al. Neurodevelopmental disabilities and special care of 5-year-old children born before 33 weeks of gestation (the EPIPAGE study): a longitudinal cohort study. Lancet 2008; 371: 813-820
• 70 Flynn RS, Huber MD, DeMauro SB. Predictive value of the BSID-II and the Bayley-III for early school age cognitive function in very preterm infants. Glob Pediatr Health 2020; 7 2333794×20973146