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Resilience and Vulnerability: Neurodevelopment of Very Preterm Children at Four Years of Age.

ABSTRACT: Children born very preterm (VPT) are at high-risk for altered brain development and impaired neurodevelopmental outcomes but are not well-studied before school-age. We investigated 64 four-year-olds: 37 VPT children [<32 weeks gestational age [GA]; 22 males; mean GA: 28.8 weeks ± 1.6], 25 full-term (FT) children (12 males), plus two VPT cases with ventriculomegaly and exceptionally resilient outcomes. All children underwent high-resolution structural magnetic resonance imaging and developmental assessments. Measures of brain volume, cortical thickness, and surface area were obtained. Children born VPT demonstrated reduced cerebral and cerebellar white matter volumes yet increased cerebral gray matter, temporal lobe, occipital lobe and ventricle volumes after adjusting for total brain volume. Cortical thickness was greater in the VPT children compared to FT children across all lobes. On developmental assessments, the VPT children scored lower on average than FT children while the two cases had intact cognitive abilities. In addition to larger ventricle volumes, the two cases had white matter and gray matter volumes within the ranges of the FT children. The VPT children displayed distinct differences in structural brain volumes at 4 years of age, consistent with delayed maturation. The cases with persistent ventriculomegaly and good cognitive outcomes displayed typical gray matter and increased white matter volumes, indicating a potential protective developmental phenomenon contributing to their intact cognitive abilities.

SUBMITTER: Young JM

PROVIDER: S-EPMC7372104 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Resilience and Vulnerability: Neurodevelopment of Very Preterm Children at Four Years of Age.

Young Julia M JM Vandewouw Marlee M MM Whyte Hilary E A HEA Leijser Lara M LM Taylor Margot J MJ

Frontiers in human neuroscience 20200714

Children born very preterm (VPT) are at high-risk for altered brain development and impaired neurodevelopmental outcomes but are not well-studied before school-age. We investigated 64 four-year-olds: 37 VPT children [<32 weeks gestational age [GA]; 22 males; mean GA: 28.8 weeks ± 1.6], 25 full-term (FT) children (12 males), plus two VPT cases with ventriculomegaly and exceptionally resilient outcomes. All children underwent high-resolution structural magnetic resonance imaging and developmental ...[more]

PMID: 32760258

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Project description:BackgroundSociodemographic factors are linked to cognitive outcomes in children born very preterm (VPT; ≤30 weeks gestation). The influence of maternal intellectual ability, a heritable trait, is unknown. Also undetermined is the extent to which associations between maternal and child intellectual ability vary according to parenting behaviors that target cognitive stimulation in the home.MethodsAt age 5 years, 84 VPT and 38 demographically matched full-term (FT) children underwent neurodevelopmental assessment. Children's intellectual ability was assessed using The Wechsler Preschool Primary Scale of Intelligence-III, and language was assessed with the Clinical Evaluation of Language Fundamentals Preschool-2. The Wechsler Test of Adult Reading estimated maternal intellectual ability. The StimQ-Preschool questionnaire provided a measure of cognitive stimulation in the home. Linear mixed-effects models examined independent effects and interactions between maternal intellectual ability and cognitive stimulation on children's outcomes.ResultsAfter covariate adjustment, maternal intellectual ability was associated with child intellectual (p < .001) and language (p = .002) abilities. Stronger associations were observed in FT mother-child dyads (B = .63, p = .04) than VPT dyads (B = .42, p = .01). Mothers of VPT children reported lower levels of Parental Involvement in Developmental Advance (p = .007) and Parental Verbal Responsiveness (p = .04). Group differences in Parental Involvement in Developmental Advance, but not Parental Verbal Responsivity, persisted after adjusting for social background (p = .03). There was no evidence of an interaction between maternal intellectual ability and Parental Involvement in Developmental Advance (p = .34). Instead, maternal intellectual ability (p < .001) and Parental Involvement in Developmental Advance (p = .05) independently predicted VPT children's outcomes.ConclusionsMaternal intellectual ability is an important trait linked to VPT and FT children's intellectual and language outcomes. Prematurity increases variation in the heritability of intellectual ability and shifts children from the expected range based on maternal ability. Parental involvement in activities that help children master new skills may promote cognitive development in VPT children born to mothers of lower intellectual ability.

Project description:BackgroundVery preterm (VPT; <30 weeks gestation) children are a heterogeneous group, yet the co-occurrence of psychiatric and neurodevelopmental impairments remains unclear. Moreover, the clinical and socio-environmental factors that promote resilient developmental outcomes among VPT children are poorly understood.MethodsOne hundred and twenty five children (85 VPT and 40 full-term) underwent neurodevelopmental evaluation at age 5-years. Parents and teachers completed measures of internalizing, externalizing, attention-deficit/hyperactivity (ADHD), and autism symptoms. Psychiatric and neurodevelopmental measures were analyzed using Latent Profile Analysis. Multinomial regression examined the extent that infant, sociodemographic, and family factors, collected prospectively from birth to follow-up, independently differentiated resilient and impaired children.ResultsFour latent profiles were identified, including a Typically Developing Group which represented 27.1% of the VPT group and 65.0% of the full-term group, an At-Risk Group with mild psychiatric and neurodevelopmental problems (VPT 44.7%, full-term 22.5%), a Psychiatric Group with moderate-to-severe psychiatric ratings (VPT 12.9%, full-term 10.0%), and a school-based Inattentive/Hyperactive Group (VPT 15.3%, full-term 2.5%). Clinical diagnoses were highest among the Psychiatric Group (80%). Factors that differentiated resilient and impaired subgroups of VPT children included prolonged exposure to maternal psychosocial distress (p ? .04), current family dysfunction (p ? .05), and maternal ADHD symptoms (p ? .02), whereas social risk index scores differentiated resilient and impaired full-term children (p < .03).ConclusionsLower levels of maternal distress, family dysfunction, and maternal ADHD symptoms were associated with resilience among VPT children. Maternal distress and family dysfunction are modifiable factors to be targeted as part of psychiatric interventions embedded in the long-term care of VPT children.

Dataset Information

Resilience and Vulnerability: Neurodevelopment of Very Preterm Children at Four Years of Age.

Publications

Resilience and Vulnerability: Neurodevelopment of Very Preterm Children at Four Years of Age.

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