Research Article: Longitudinal growth and emotional and behavioral problems at age 7 in moderate and late preterms

Date Published: January 31, 2019

Publisher: Public Library of Science

Author(s): Baukje M. Dotinga, Andrea F. de Winter, Inger F. A. Bocca-Tjeertes, Jorien M. Kerstjens, Sijmen A. Reijneveld, Arend F. Bos, Anneloes van Baar.


Moderately and late preterm children (MLPs, 32.0–36.9 weeks gestational age) have a greater risk of poorer growth. This seems to be associated with poorer neuropsychological functioning. Evidence is limited on whether this also holds for emotional and behavioral (EB) problems. Therefore, we assessed whether longitudinal growth from birth until age 7 was associated with EB problems at age 7 in MLPs.

This study was part of the Longitudinal Preterm Outcome Project, a prospective cohort study. Data on growth (height, weight, head circumference, and extent of catch-up growth) were obtained from assessments from birth until age 7. EB problems were assessed at age 7 with the Child Behavior Checklist. We assessed whether growth and EB problems were associated using logistic regression analyses, adjusting for multiple birth, parity, and socioeconomic status.

We included 248 MLPs. Median gestational age was 34 weeks (interquartile range: 33–35 weeks). Mean birth weight was 2.2 kg (standard deviation: 0.5 kg). Postnatal growth measures were below the Dutch reference norm. EB problems were more prevalent in MLPs than in the general Dutch population. Generally, we found no associations between growth and EB problems; odds ratios ranged from 0.20 to 2.72.

In MLPs, postnatal growth from birth until age 7 was not associated with EB problems at age 7. Poorer growth thus seems to relate to neuropsychological problems, but not to EB problems. This suggests that the etiologies of these problems differ at least partially.

Partial Text

Worldwide, approximately 10% of all children are born preterm [1]. Moderate (32.0–33.9 weeks gestational age, GA) and late (34.0–36.9 weeks GA) prematurity accounts for approximately 80% of all preterm births [1]. Moderately and late preterm (MLP) birth leads to a greater risk of adverse childhood outcomes, including growth restraint [2], impaired neuropsychological functioning [3], and emotional and behavioral (EB) problems [4–8]. Previous studies have shown that in preterm-born children, these adverse outcomes co-occur and may be interrelated: poorer growth seems to be associated with poorer neuropsychological functioning [9,10] and children with poorer neuropsychological functioning often also have more EB problems [11,12]. In MLPs, EB problems mainly concern mood and emotion disturbances [8,13]. EB problems in childhood have been associated with a variety of mental health disorders in later life, including anxiety and depressive disorders [14–16]. Gaining more insight into the etiology of EB problems in childhood may improve detection, intervention strategies, and outcomes of these problems.

We included 248 MLPs, with a median GA of 34 weeks (interquartile rage: 33–35 weeks) and a mean birth weight of 2.2 kg (SD: 0.5 kg). Background characteristics are shown in Table 1. Compared with the participating children, fewer non-participating children were small-for-gestational age at birth and more came from families with low SES. Other characteristics, including gender, gestational age and birth weight, did not differ significantly between the two groups.

This study showed that nearly all measures of longitudinal growth from birth until the age of 7 years were not associated with EB problems at the age of 7 years in MLPs. MLPs only had a greater risk of internalizing problems at the age of 7 years in case of greater height gain in the first year of life.

In MLPs, longitudinal growth from birth until the age of 7 years was not associated with EB problems at the age of 7 years. These findings suggest that the etiologies of EB problems and of poorer neuropsychological functioning are at least partly different. These etiologies require further research.




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