Psychiatric morbidity in two low birth weight groups assessed by diagnostic interview in young adulthood

Aim: To study the prevalence and characteristics of psychiatric symptoms and disorders in young adults born with low birth weight. Methods: At 20 years of age 44 very low birth weight (VLBW: birth weight ≤1500 g), 55 term born small for gestational age (SGA: birth weight <10th percentile) and 75 control subjects born 1986–1988 were assessed using the interview Schedule for Affective Disorders and Schizophrenia for School‐age children and Structured Clinical Interview for DSM‐IV Personality Disorders, Children’s Global Assessment Scale and Attention deficit hyperactivity disorder (ADHD) Rating Scale IV; self‐report and parent report. Results: Fourteen (33%) VLBW versus six (8%) control participants had a definite psychiatric disorder: OR = 5.6 (1.9–15.9). In the term SGA group, 14 (26%) had a disorder: OR = 3.9 (1.4–11.0) vs controls. Anxiety disorders and ADHD were the most frequent diagnoses. The differences were not explained by gender, assessment age or parental socioeconomic status. ADHD Rating Scale mean scores were higher in parent reports in the VLBW group and in self‐reports in the term SGA group compared with the control group. Conclusion: Children born with low birth weight whether caused by preterm birth or by growth retardation at term seem to be at increased risk for psychiatric disorders as young adults.     

Regional fat distribution in children born preterm evaluated at school age

Children born preterm may have aberrant adiposity. At school age, we evaluated body fat and fat distribution in 45 former preterm infants (birth weight < or = 1800 g and gestational age < 34 weeks) and 40 children born at term using dual-energy x-ray absorptiometry. Children born preterm exhibited lower total body fat mass and total body fat mass index compared with children born at term. Fat mass indexes in the limbs but not the trunk were lower in children born preterm than in children born at term. In conclusion, children born preterm, evaluated at school age, may be at risk for altered regional adiposity.     

Birth weight <1501 g and respiratory health at age 14.

AIMS: To determine the respiratory health in adolescence of children of birth weight <1501 g, and to compare the results with normal birthweight controls. METHODS: Prospective cohort study of children born in the Royal Women's Hospital, Melbourne. Two cohorts of preterm children (86 consecutive survivors 500-999 g birth weight, and 124 consecutive survivors 1000-1500 g birth weight) and a control group of 60 randomly selected children >2499 g birth weight were studied. Children were assessed at 14 years of age. A paediatrician determined the clinical respiratory status. Lung function was measured according to standard guidelines. RESULTS: Of 180 preterm children seen at age 14, 42 (23%) had bronchopulmonary dysplasia (BPD) in the newborn period. Readmission to hospital for respiratory ill health was infrequent in all groups and the rates of asthma were similar (15% in the 500-999 g birth weight group, 21% in the 1000-1500 g birth weight group, 21% in controls; 19% BPD, 18% no BPD). Overall, lung function was mostly within the normal range for all cohorts; few children had lung function abnormalities in clinically significant ranges. However, the preterm children had significantly lower values for variables reflecting flow. Lung function in children of 500-999 g birth weight was similar to children of 1000-1500 g birth weight. Preterm children with BPD had significantly lower values for variables reflecting flow than children without BPD. CONCLUSIONS: The respiratory health of children of birth weight <1501 g at 14 years of age is comparable to that of term controls.     

294例宫内发育迟缓儿出生2年内的身长追长观察

目的：对294例宫内发育迟缓（IUGR）儿童出生2年内的身长追长观察,了解不同性别、不同胎龄、不同出生体重IUGR儿身长追长情况。方法：294例IUGR儿童与300例足月正常儿在出生后4、6、9、12、15、18、21、24月龄随访,测量其身长,计算身长增长值,比较身长增长情况。结果：IUGR儿童身长追长成功率男女分别为72.2%和71.5%（P=0.90）;早产小样儿与足月小样儿追长成功率分别为77.4%、68.6%（P=0.11）;出生体重1500~2499 g者的身长追长成功率较出生体重<1500 g和≥2500 g者高（P<0.01）。IUGR男童在4、6月龄及18、21、24月龄测得的身长增长值明显高于正常儿（P<0.05）;女童在4、6、9、12及21月龄测得的身长增长值明显高于正常儿。男童早产小样儿在6月龄及9月龄身长增长值明显大于足月小样儿,女童早产小样儿在4月龄及18月龄身长增长值明显大于足月小样儿。不论男女,出生体重<1500 g者在4月龄身长增长值均明显大于≥2500 g者;男童1500～2499 g者在4、6、18、21及24月龄身长增长值明显大于≥2500 g者,女童1500～2499 g者在4、6、9、12及21月龄身长增长明显大于≥2500 g者。结论：IUGR女童的追长以出生后第一年为主,而男童除出生半年内追长外,在出生第二年仍追长明显。早产小样儿的追长比足月小样儿好。出生体重<1500 g者及1500～2499 g者的追长比≥2500 g者好。     

Population based,controlled study of behavioural problems and psychiatric disorders in low birthweight children at 11 years of age

OBJECTIVE: To evaluate the risk of long term behavioural problems and psychiatric disorders associated with being born with low birth weight. DESIGN/STUDY GROUPS: A population based, controlled follow up study at 11 years of age of 130 low birthweight (LBW) children weighing less than 2000 g at birth who were without major handicaps, and a random sample of 131 normal birthweight (NBW) children born at term weighing over 3000 g. MAIN OUTCOME MEASURES: Validated questionnaires addressing behaviour completed by mothers and teachers and child evaluation by child psychiatrist using a semistructured interview. RESULTS: Behavioural problems, as defined by abnormal scores on more than four of 32 measures, were found in 40% of LBW children compared with 7% of NBW children (odds ratio (OR) 8.2, 95% confidence interval (CI) 3 to 25, p = 0001). A psychiatric disorder was diagnosed in 27% of the LBW children compared with 9% of the NBW children (OR 3.1, 95% CI 1.5 to 6.5, p = 0.001). The LBW children were more often inattentive, had social problems, and low self esteem. None of the pre-, neo-, or peri-natal variables in the LBW group were statistically significant predictors of behavioural outcomes or the presence of psychiatric disorders. Behavioural problems and psychiatric disorders were as common in those with birth weight less than 1500 g as those with birth weight 1500-2000 g. CONCLUSION: An increased risk of behavioural problems and psychiatric disorders persists in LBW adolescents.     

Birth weight <1501 g and respiratory health at age 14

AIMS—To determine the respiratory health in adolescence of children of birth weight <1501 g, and to compare the results with normal birthweight controls.METHODS—Prospective cohort study of children born in the Royal Women''s Hospital, Melbourne. Two cohorts of preterm children (86 consecutive survivors 500-999 g birth weight, and 124 consecutive survivors 1000-1500 g birth weight) and a control group of 60 randomly selected children >2499 g birth weight were studied. Children were assessed at 14 years of age. A paediatrician determined the clinical respiratory status. Lung function was measured according to standard guidelines.RESULTS—Of 180 preterm children seen at age 14, 42 (23%) had bronchopulmonary dysplasia (BPD) in the newborn period. Readmission to hospital for respiratory ill health was infrequent in all groups and the rates of asthma were similar (15% in the 500-999 g birth weight group, 21% in the 1000-1500 g birth weight group, 21% in controls; 19% BPD, 18% no BPD). Overall, lung function was mostly within the normal range for all cohorts; few children had lung function abnormalities in clinically significant ranges. However, the preterm children had significantly lower values for variables reflecting flow. Lung function in children of 500-999 g birth weight was similar to children of 1000-1500 g birth weight. Preterm children with BPD had significantly lower values for variables reflecting flow than children without BPD.CONCLUSIONS—The respiratory health of children of birth weight <1501 g at 14 years of age is comparable to that of term controls.     

Asthma, lung function and allergy in 12-year-old children with very low birth weight: A prospective study

We assessed the relationship between very low birth weight (VLBW) (≤1500 g) and the development of asthma, lung function and atopy. The study groups comprised 74 of all 86 (86%) VLBW and 64 of all 86 (74%) matched term children who were prospectively followed for 12 years. A questionnaire on asthmatic and allergic symptoms was completed and skin prick tests, spirometry and hypertonic saline provocation tests were performed at 12 years of age. Cytokine secretion was analysed in stimulated blood leukocyte cultures in 28 VLBW and 23 term children. A history of asthma was more frequent among the VLBW children, as compared with the term children at age 12 (22% vs. 9%, p = 0.046). Among the VLBW children, very preterm birth (gestational age: week 25 to 29) (RR 2.5, 95%CI 1.1–5.8), neonatal mechanical ventilation (RR 2.8, 95%CI 1.2–6.4) and neonatal oxygen supplementation (RR 4.3, 95%CI 1.3–14.0) were significantly associated with a history of asthma by the age of 12 years in univariate analyses. In multivariate logistic regression, neonatal oxygen supplementation ≥ 9 days was the only remaining significant risk factor for a history of asthma (adjusted OR 6.7, 95%CI 1.0–44). The VLBW children who required mechanical ventilation during the neonatal period were more likely to have bronchial hyperresponsiveness than those not requiring mechanical ventilation (60% vs. 28%, p = 0.050). The spirometric values were similar among the VLBW and the term children at 12 years. Very low birth weight was not significantly related to allergic rhinoconjunctivitis, eczema or positive skin prick tests. Furthermore, the levels of IL‐4, IL‐5 and IFN‐γ in stimulated cell cultures were similar in the VLBW and the term children. A history of asthma by 12 years of age was twice as common among the VLBW as the term children, and neonatal oxygen supplementation seemed to be associated with the increased risk. Furthermore, mechanical ventilation during the neonatal period was associated with bronchial hyperresponsiveness at age 12. Very low birth weight per se was not, however, related to atopy.     

Influence of maternal birth weight on rate of fetal growth and duration of gestation

Birth certificates of infants born in Tennessee during 1979 to 1984 were linked with the birth certificates of their mothers, who were born in Tennessee during 1959 to 1966 (n = 43,891) to study the association between maternal and infant birth weights. A highly significant association (P less than 0.0001) between maternal and infant birth weights was found for both blacks and whites. Women who weighed 4000 to 4499 g at birth were at lowest risk for delivery of a small for gestational age (SGA) infant (5.9% for whites, 4.8% for blacks). The risk of giving birth to an SGA infant increased with decreasing maternal birth weight, reaching a maximum of 19.8% for white mothers who weighed 2000 to 2499 g at birth, and 20.0% for black mothers who weighed 1000 to 1499 g at birth. In contrast, the rate of preterm birth varied much less by maternal birth weight for both whites and blacks. These data suggest that maternal birth weight exerts a stronger influence on intrauterine growth than on the duration of gestation. Women who were smaller than average at birth should be considered at high risk for delivery of an SGA infant.     

Motor skills in adolescents with low birth weight

BACKGROUND: Minor motor problems have been reported in low birthweight children, but few studies have assessed motor skills in adolescents. OBJECTIVE: To examine the prevalence of motor problems in adolescents with low birth weight. METHOD: Fifty four very low birthweight (VLBW: birth weight < or = 1500 g), 59 term small for gestational age (SGA: birth weight < 10th centile), and 83 control (birth weight > or = 10th centile at term) children were assessed with the Movement assessment battery for children (Movement ABC) at the age of 14 in a population based study. RESULTS: One in four VLBW children (odds ratio (OR) 9.3, 95% confidence interval (CI) 2.5 to 34.5) and one in six SGA children (OR 4.7, 95%CI 1.2 to 18.4) had motor problems compared with controls (3.7%). There were no sex differences in motor problems in the VLBW group, and the increased risk was consistent across the continuum of the Movement ABC. For SGA children, the increased risk of motor problems was particularly in manual dexterity in boys. CONCLUSION: VLBW and SGA adolescents have increased risk of motor problems compared with control children.     

Underlying maternal and pregnancy‐related conditions account for a substantial proportion of neonatal morbidity in late preterm infants

Aim

We studied the impact of maternal and pregnancy‐related conditions and the effect of gestational age itself, on the health of infants born late preterm.

Methods

Singletons born in gestational weeks 34 + 0 to 41 + 6 in 1995–2013 in the southern region of Sweden were identified from a perinatal register. We found 14 030 infants born late preterm and 294 814 born at term. A hierarchical system was developed to examine the impact of pregnancy complications. The outcomes studied were as follows: neonatal death, central nervous system (CNS) or respiratory disease, infection, neonatal admission and respiratory support. Odds ratios (OR) and 95% confidence intervals (95% CI) were obtained using logistic regression analyses.

Results

Late preterm infants were at increased risk for all outcomes compared to term infants, with adjusted ORs from 13.1 (95% CI: 12.7–13.6) for neonatal admission to 2.3 (95% CI: 1.8–2.9) for infections. Late preterm birth after preterm prelabour rupture of membranes was associated with an overall lower risk compared to late preterm births due to other causes. Exposure to antepartum haemorrhage or maternal diabetes increased the risk for CNS and respiratory morbidity.

Conclusion

Morbidity decreased in late preterm infants with increasing gestational age. Underlying conditions accounted for a substantial part of the morbidity.     

Health status development in a cohort of preterm children

OBJECTIVE: To determine the impact of preterm birth on health status (HS) development at the ages of 5 and 10 years in a cohort of children born before term. SAMPLE: Six hundred eighty-eight children, born in 1983 with a gestational age of <32 weeks and a birth weight of <1500 g. DESIGN: Prospectively collected HS variables, obtained from the parents, were analyzed in a longitudinal perspective by using principal component analyses. RESULTS: One third of the sample had minor to severe HS problems at both ages of measurement. One third had problems on one assessment only. The remainder of the sample had no HS problems at either age. The analyses grouped the HS variables into 3 combinations. Problems in basic functioning, such as mobility or speech, decreased with age. Negative moods substantially increased, and concentration problems increased slightly. Specifically at risk were preterm born children with handicaps, boys, and children who were small for gestational age. CONCLUSION: According to the parents, one third of the cohort had no HS problems at either age. The pattern of HS problems of the preterm born children changed between 5 and 10 years of age.     

Attachment representations and stress in mothers of very low birth weight preterm infants at two years of age

IntroductionThere is a consensus that prematurity could affect the risk of attachment impairment.Material and methodsWe studied 90 very low birth weights preterm children (<1500 g) with follow-ups at Cruces Hospital (Bizkaia) and 96 healthy children born at term with similar age and sociodemographic characteristics. Our objective is to assess maternal stress and link model in accordance to attachment representations of mothers on both groups by using R Interview for Maternal Representations.ResultsPreterm infants had a medium-to-severe degree of immaturity and biological risk: mean gestational age of 29.9 weeks and birth weight 1159.76 gr, with 57% staying in the ICU ≥ 1 week. Mothers of preterm infants reported higher levels of stress during their first year of life (61%) than controls (39%), but no significant differences were found in link model (attachment representations) between the two groups.Discussion and conclusionsThe results confirm that preterm birth has a great influence on maternal emotional responses, and indicate that stress responses in parents and alarm signs for attachment problems should be assessed as early as possible.     

Gestational and neonatal characteristics of children with cystic fibrosis: a cohort study

OBJECTIVE: To examine whether the birth weight (BW) and the risks of being pre-term, low birth weight (LBW), and small for gestational age (SGA) of children with cystic fibrosis (CF) are different from nonaffected children. STUDY DESIGN: Retrospective cohort study. We examined all the children with CF born in Tuscany, Italy, from 1991 to 2002 (n = 70) comparing them to the entire population of non-CF-affected children born in the same period (n = 290,059). RESULTS: The mean BW of newborns with CF was 246.2 g lower than the mean BW of the non-CF neonatal population (P = .0003). Children with CF had a higher risk of being born pre-term (RR 2.62, P = .001), LBW (RR 2.66, P = .0009), and SGA (RR = 1.74, P = .04) than the non-CF-affected children. The mean BW of term newborns with CF was 205.7 g lower than that of term non-CF-affected babies (P = .0002). CONCLUSIONS: Our data show an association between CF and reduced BW and show a greater risk of being pre-term for babies with CF.     

Prevalence and risk factors for sleep-disordered breathing in 8- to 11-year-old children: association with race and prematurity

OBJECTIVES: To evaluate the extent to which sleep-disordered breathing (SDB) varies with putative demographic and medical risk factors and to estimate the prevalence of undiagnosed SDB. STUDY DESIGN: Prospective, cross-sectional study in a population-based cohort of 850 children (41% black, 46% preterm), 8 to 11 years of age. Participants' caretakers completed questionnaires about health and sleep. Children underwent overnight in-home cardiorespiratory recordings of airflow, respiratory effort, oximetry, and electrocardiography. SDB was identified by respiratory disturbance indices commonly applied in clinical practice. Risk factors were estimated by logistic regression. Prevalence was derived from cohort-specific estimates with birth weights from US live births data. RESULTS: Using the most inclusive definition, SDB was detected in 40 (4.7%) participants, with prevalence varying widely across population subsets. Depending on the definition used, SDB was 4 to 6 times more likely in black children compared with white children and almost 3 to 5 times more likely in former preterm compared with term children. The estimated population prevalence of SDB was 2.2% (95% CI, 1.2%, 3.2%). CONCLUSIONS: SDB is a relatively common condition in 8- to 11-year-old children. Potentially vulnerable subgroups, black children, and former preterm infants, are at increased risk.     

Preterm birth and carotid diameter and stiffness in childhood

BACKGROUND AND AIM: Low birthweight, either as a result of poor foetal growth or preterm birth, is a risk factor for stroke in adult life. Carotid stiffening, an early marker of atheromatous disease, has been found in low-birthweight children born at term. We hypothesized that carotid artery growth and dynamic properties are permanently affected by preterm birth. METHODS: Carotid artery stiffness and dimensions in 56 school children, 39 born very preterm (mean gestational age [GA] 29 weeks) and 17 controls born at term, were studied by ultrasonic measurements of the pulsatile movements of the vessel wall. RESULTS: The carotid artery diameter was 6.4 mm both in children born preterm and at term (p=0.99). No difference in carotid stiffness was found. Within the preterm group, no differences could be seen between those born small for gestational age (SGA) or appropriate for gestational age (AGA). CONCLUSIONS: Carotid artery elasticity and structure are not altered after preterm birth. The mechanisms behind the increased stroke risk in adults born preterm remain unresolved.     

Maternal and paternal age and risk of autism spectrum disorders

OBJECTIVE: To explore the association between maternal and paternal age and risk of autism spectrum disorders (ASDs) in offspring. DESIGN: Historical birth cohort study. SETTING: Kaiser Permanente (KP) in Northern California. PARTICIPANTS: All singleton children born at KP from January 1, 1995, to December 31, 1999, were included in the study. We identified 593 children who had ASD diagnoses (International Classification of Diseases, Ninth Revision, Clinical Modification, code 299.0 or 299.8) recorded 2 or more times in KP outpatient databases before May 2005. These children were compared with all 132,251 remaining singleton KP births. Main Exposures Maternal and paternal age at birth of offspring. MAIN OUTCOME MEASURES: Relative risks (RRs) estimated from proportional hazards regression models. Risk of ASDs evaluated in relation to maternal and paternal age, adjusted for each other and for the sex, birth date, and birth order of the child, maternal and paternal educational level, and maternal and paternal race/ethnicity. RESULTS: Risk of ASDs increased significantly with each 10-year increase in maternal age (adjusted RR, 1.31; 95% confidence interval [CI], 1.07-1.62) and paternal age (RR, 1.28; 95% CI, 1.09-1.51). Adjusted RRs for both maternal and paternal age were elevated for children with autistic disorder (maternal age: RR, 1.18; 95% CI, 0.87-1.60; paternal age: RR, 1.34; 95% CI, 1.06-1.69) and children with Asperger disorder or pervasive developmental disorder not otherwise specified (maternal age: RR, 1.45; 95% CI, 1.09-1.93; paternal age: RR, 1.24; 95% CI, 0.99-1.55). Associations with parental age were somewhat stronger for girls than for boys, although sex differences were not statistically significant. CONCLUSION: Advanced maternal and paternal ages are independently associated with ASD risk.     

The risk of psychiatric disorders in individuals born prematurely in Denmark from 1974 to 1996

Aim: To investigate the risk of developing psychiatric disorders in individuals born prematurely (born before 37 weeks of gestation). Methods: The study is a longitudinal register‐based study including all live‐born individuals in Denmark from 1974 to 1996. Poisson regression models including well‐known confounders were used to investigate the rate ratio of psychiatric disorders at the age of 11–34 years in the individuals born prematurely. Results: A total of 1 545 641 individuals were born from 1974 to 1996. Of these, 1 348 106 live‐born individuals constituted the study cohort. Rate ratios of psychiatric disorders, in total, increased in proportion to the degree of prematurity. The rate ratio of major psychiatric disorder was increased in individuals born with a gestational age below 28 weeks compared to persons born with a gestational age of 39–45 weeks (RR = 1.88 (95% CI: 1.25–2.83)). Similarly, the rate ratios of minor psychiatric disorder (RR = 1.63 (95% CI: 1.29–2.06)) and psychotropic drugs purchased (RR = 1.35 (95% CI: 0.98–1.86)) were increased. Conclusion: The risk of minor as well as major psychiatric disorders during adolescence and young adulthood increases in proportion to the degree of prematurity. The relative risk, however, is small compared to the risks of cerebral palsy or low intelligence.     

Developmental data in preschool children born after prolonged pregnancy

Aim: To evaluate children born post-term (gestational age ≥42 weeks) with respect to developmental data obtained at the ages of 4 and 5.5 y. Methods: The study population included all children (n=354) born in 1991 at Huddinge University Hospital with a gestational age of ≥42 wk. The births were identified and perinatal data were collected through the Swedish National Birth Registry. Developmental assessments from the child health centres were analysed. Children born at term, but before a gestational age of 42 wk, served as controls. Logistic regression analysis was used to analyse the data. Results: Children born post-term had more developmental deviations than the controls (estimated odds ratio 2.20; 95% CI: 1.29-3.85). Boys had more deviations than girls (estimated odds ratio 1.92; 95% CI: 1.11-3.45).

Conclusion: Our results indicate that there might be an association between post-term birth and developmental deviations.     

Is low birth weight a risk factor for asthma during adolescence?

The effect of low birth weight on the incidence of asthma by 17 years of age was investigated by studying medical draft examination records of 20,312 male subjects born in Jerusalem between January 1967 and December 1971. Additional information on birth weight and other demographic factors was abstracted from the Jerusalem Perinatal Study computerised database. A stepwise multiple logistic regression was used to estimate the odds ratios for developing asthma by 17 years of age in 500 g birthweight categories from less than 2000 g to 4500 g. The odds ratios were adjusted for the confounding effects of ethnic origin, social class (determined by area of residence), paternal education, maternal age, and birth order. The group with low birth weights (less than 2500 g, n = 1004) had a significantly increased risk of developing asthma by 17 years of age, with an adjusted odds ratio of 1.44 (95% confidence interval (CI) 0.79 to 2.66) for birthweight group less than 2000 g and 1.49 (95% CI 1.05 to 2.12) for birthweight group 2000-2499 g compared with the reference group of 3000-3499 g. We conclude that infants with birth weights of less than 2500 g may have a higher risk of asthma during childhood and adolescence than infants who were heavier at birth.     

Second-generation consequences of small-for-dates birth

This is the first reported study of birth outcomes of a group of women whose own birth weights and gestational ages had been previously recorded. Births occurring from 1972 to 1983 among 1154 Swedish women, born from 1955 to 1965, were studied. Women who were themselves small for gestational age (SGA) at birth were at increased risk of giving birth to a SGA infant (odds ratio = 2.21, 95% confidence interval = 1.41, 3.48). Women who had been SGA had an even greater increase in risk of giving birth to a preterm infant (odds ratio = 2.96, 95% confidence interval = 1.47, 5.94). Women who were preterm at birth were not at increased risk of giving birth to either preterm (odds ratio = 0.65, 95% confidence interval = 0.15, 2.74) or SGA (odds ratio 1.21, 95% confidence interval = 0.62, 2.38) infants. It is concluded that the long-term effects of intrauterine growth retardation may extend to the next generation; women who had been SGA should be considered at increased risk to give birth to both growth-retarded and preterm infants.