Social Adversity and Cognitive, Language, and Motor Development of Very Preterm Children from 2 to 5 Years of Age

• Published in: The Journal of pediatrics Vol. 203; pp. 177 - 184.e1
• Main Authors: Lean, Rachel E., Paul, Rachel A., Smyser, Tara A., Smyser, Christopher D., Rogers, Cynthia E.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2018
• Subjects: Age Factors; Child, Preschool; cognition; Cognition Disorders - diagnosis; Cognition Disorders - epidemiology; development; Developmental Disabilities - diagnosis; Developmental Disabilities - epidemiology; Female; follow-up; Gestational Age; Humans; Infant; Infant, Extremely Premature - growth & development; Infant, Newborn; language; Language Development; Longitudinal Studies; Male; motor; Motor Skills - physiology; Movement Disorders - diagnosis; Movement Disorders - epidemiology; Multivariate Analysis; Predictive Value of Tests; Regression Analysis; Risk Assessment; social adversity; Social Environment; United States; very preterm; United States; motor; development; MABC-2; cognition; MRI; Bayley-III; WTAR; PSI; FAD; NICU; language; WMA; LMM; FT; follow-up; very preterm; FSIQ; social adversity; CELF-P2
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2018.07.110

To assess the extent to which social and family factors explain variability in cognitive, language, and motor development among very preterm (<30 weeks of gestation) children from 2 to 5 years of age. As part of a longitudinal study, very preterm children recruited as neonates were assessed at 2 (n = 87) and 5 (n = 83) years of age using standardized tests of cognitive, language, and motor ability alongside demographically matched full term (FT) children (n = 63). For very preterm children, developmental change scores were calculated for each domain to assess within-individual variability to 5 years of age. Multivariate regression and mixed-effect models examined social risk index, parenting stress, family functioning, and maternal intellectual ability as predictors of developmental variation among very preterm children. Very preterm children demonstrated poorer cognitive, language, and motor abilities than FT children at 2 (P ≤ .001) and 5 (P < .002) years of age. Social adversity was associated with cognitive (P < .001) and language (P < .001) outcomes at both ages, with parenting stress also related to cognitive outcomes (P = .03). Infant medical risk was associated with motor outcome at 5 years (P=.01). Very preterm children showed considerable within-individual variation between assessments. Among very preterm children, neonatal white matter abnormalities predicted worsening cognitive (P=.04) and motor development (P = .01). Social risk index predicted worsening language development (P = .04), but this association was subsequently explained by dysfunctional maternal affective involvement (P = .01) and lower maternal intellectual ability (P = .05). Both clinical and socioenvironmental factors are associated with cognitive, language, and motor developmental variation among very preterm children from infancy to early school age.