Skip to main content

Premature Infants: The Behavioral Phenotype of the Preterm Survivor

  • Chapter
  • First Online:

Abstract

Approximately one of ten children was born preterm based on current global estimates. While the outcomes of the preterm survivor are promising, with a small fraction experiencing significant neurodevelopmental disability, many children born preterm will experience subtle, discreet, and additive challenges that can contribute to school challenges. This chapter describes the pattern of neurodevelopmental outcomes for the child born preterm, now increasingly referred to as the behavioral phenotype of prematurity. Awareness of this pattern is critical for the practitioner following these children.

This is a preview of subscription content, log in via an institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   199.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Hodapp, R. M., & Fidler, D. J. (1999). Special education and genetics: Connections for the 21st century. The Journal of Special Education, 33, 130–137.

    Article  Google Scholar 

  2. Bach, S. A., & Miller, S. P. (2014). Brain injury in premature neonates: A primary cerebral dysmaturation disorder? Annals of Neurology, 75, 469–486.

    Article  Google Scholar 

  3. Church, P. T., Luther, M., & Asztalos, E. (2012). The perfect storm: Minor morbidities in the preterm survivor. Current Pediatric Reviews, 8, 142–151.

    Article  Google Scholar 

  4. Blencowe, H., Cousens, S., Oestergaard, M. Z., et al. (2012). National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: A systematic analysis and implications. Lancet, 379, 2162–2172.

    Article  PubMed  Google Scholar 

  5. March of Dimes, PMNCH, Save the Children, WHO. (2012). In C. P. Howson, M. V. Kinney, & J. E. Lawn (Eds.), Born too soon: The global action report on preterm birth. Geneva: World Health Organization.

    Google Scholar 

  6. Alyward, G. P. (2005). Neurodevelopmental Outcomes of Infants Born Prematurely. Journal of Developmental and Behavioral Pediatrics, 26, 427–440.

    Article  Google Scholar 

  7. Chyi, L., Lee, H. C., Hintz, S. R., Gould, J. B., & Sutcliffe, T. L. (2008). School outcomes of late preterm infants: Special needs and challenges for infants born at 32 to 36 weeks gestation. The Journal of Pediatrics, 153, 25–31.

    Article  PubMed  Google Scholar 

  8. Talge, N. M., Holzman, C., Wang, J., Lucia, V., Gardner, J., & Breslau, N. (2010). Late-preterm birth and its association with cognitive and social outcomes at 6 years of Age. Pediatrics, 126, 1124–1131.

    Article  PubMed  Google Scholar 

  9. Wolraich, M. L., Felice, M. E., & Drotar, D. (1996). The classification of child and adolescent mental diagnoses in primary care. Diagnostic and statistical manual for primary care (DSM-PC) child and adolescent version. Elk Grove Village: American Academy of Pediatrics.

    Google Scholar 

  10. Accardo, P. J., Accardo, J. A., & Capute, A. J. (2008). A neurodevelopmental perspective on the continuum of developmental disabilities. In P. J. Accardo (Ed.), Capute & Accardo’s neurodevelopmental disabilities in infancy and childhood (3rd ed.). Baltimore: Brooks Publishing.

    Google Scholar 

  11. National Research Council and Institute of Medicine. (2000). From neurons to neighborhoods: The science of early childhood development. In J. P. Shonkoff & D. A. Phillips (Eds.), Board on children, youth, and families, commission on behavioral and social sciences and education. Washington, DC: National Academy Press.

    Google Scholar 

  12. Kolb, B., & Gibb, R. (2011). Brain plasticity and behaviour in the developing brain. Journal of the Canadian Academy of Child and Adolescent Psychiatry, 20, 265–276.

    PubMed  PubMed Central  Google Scholar 

  13. Asztalos, E. V., Church, P. T., Riley, P., Shah, P., & Canadian Neonatal Network and Canadian Neonatal Follow Up Network Investigators. (2017). Neonatal factors associated with a good neurodevelopmental outcome in very preterm infants. American Journal of Perinatology, 34, 388–396.

    PubMed  Google Scholar 

  14. Asztalos, E. V., Church, P. T., Riley, P., Shah, P. S., & Canadian Neonatal Network and Canadian Neonatal Follow Up Network Investigators. (2017). Association between primary caregiver education and cognitive and language development of preterm neonates. American Journal of Perinatology, 34, 364–371.

    PubMed  Google Scholar 

  15. Luciana, M. (2003). Cogntive development in chidren born preterm: Implications for theories of brain plasticity following early injury. Development and Psychopathology, 15, 1017–1047.

    Article  PubMed  Google Scholar 

  16. Synnes, A., Luu, T. M., Moddemann, D., et al. (2017). Determinants of developmental outcomes in a very preterm canadian cohort. Archives of Disease in Childhood. Fetal and Neonatal Edition, 102, F235–F234.

    Article  PubMed  Google Scholar 

  17. Volpe, J. J. (2009). Brain injury in preterm infants: A complex amalgam of destructive and developmental disturbances. The Journal-Lancet, 8, 110–124.

    Google Scholar 

  18. Volpe, J. J. (2009). Cerebellum of the premature infant: Rapidly developing, vulnerable, clinically important. Journal of Child Neurology, 24, 1085–1104.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Volpe, J. J. (1997). Brain Injury in the preterm infant—from pathogenesis to prevention. Brain and Development, 19, 519–534.

    Article  PubMed  Google Scholar 

  20. Inder, T. E., Wells, S. J., Mogridge, N. B., Spencer, C., & Volpe, J. J. (2003). Defining the nature of the cerebral abnormalities in the premature infant: A qualitative magnetic resonance imaging study. The Journal of Pediatrics, 143, 171–179.

    Article  PubMed  Google Scholar 

  21. Lickliter, R. (2011). The integrated development of sensory development. Clinics in Perinatology, 38, 591–603.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Karatzias, A., Chouliara, Z., Maxton, F., Freer, Y., & Power, K. (2007). Post-traumatic symptomatology with premature infants: A systematic review of the literature. Journal of Prenatal and Perinatal Psychology and Health, 21, 249–260.

    Google Scholar 

  23. Shah, P. E., Clements, M., & Poehlmann, J. (2011). Maternal resolution of grief after preterm birth: Implications for infant attachment security. Pediatrics, 127, 284–292.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Ment, L. R., Kesler, S., Vohr, B., et al. (2009). Longitudinal brain volume changes in preterm and term control subjects during late childhood and adolescence. Pediatrics, 123, 503–511.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Roberts, G., Lim, J., Doyle, L. W., & Anderson, P. J. (2011). High rates of school readiness difficulties at 5 years of age in very preterm infants compared with term controls. Journal of Developmental and Behavioral Pediatrics, 32, 117–124.

    Article  PubMed  Google Scholar 

  26. O’Brien, G. (2006). Behavioural phenotypes: Causes and clinical implications. Advances in Psychiatric Treatment, 12, 338–348.

    Article  Google Scholar 

  27. Hack, M., Taylor, G., Drotar, D., et al. (2005). Poor predictive validity of the bayley scales of infant development for cognitive function of extremely low birth weight children at school age. Pediatrics, 116, 333–340.

    Article  PubMed  Google Scholar 

  28. Alyward, G. P. (2005). The Conundrum of Prediction. Pediatrics, 116, 491–492.

    Article  Google Scholar 

  29. Elias, E. R., & Crocker, A. C. (2009). Intellectual disability. In W. B. Carey, A. C. Crocker, W. L. Coleman, E. R. Elias, & H. M. Feldman (Eds.), Developmental-behavioral pediatrics (4th ed.). Philadelphia: Saunders Elsevier.

    Google Scholar 

  30. Bos, A. F., & Roze, E. (2011). Neurodevelopmental outcome in preterm infants. Developmental Medicine and Child Neurology, 53, 35–39.

    Article  PubMed  Google Scholar 

  31. Marlowe, N. M., Wolke, D. M., Bracewell, M. A., et al. (2005). Neurologic and developmental disability at six years of age after extremely preterm birth. NEJM, 353, 9–19.

    Article  Google Scholar 

  32. Johnson, S., Hennessy, E., Smith, R., Trikic, R., Wolke, D., & Marlow, N. (2009). Academic attainment and special education needs in extremely preterm children at 11 years: The EPICure study. Archives of Disease in Childhood. Fetal and Neonatal Edition, 94, F283–F289.

    Article  PubMed  Google Scholar 

  33. Simms, V., Gilmore, C., Cragg, L., Marlow, N., Wolke, D., & Johnson, S. (2013). Mathematics difficulties in extremely preterm children: Evidence of a specific deficit in mathematics processing. Pediatric Research, 73, 236–244.

    Article  PubMed  Google Scholar 

  34. Mulder, H., Pitchford, N. J., & Marlow, N. (2010). Processing speed and working memory underlie academic attainment in very preterm children. Archives of Disease in Childhood. Fetal and Neonatal Edition, 95(4), F267–F272.

    Article  PubMed  Google Scholar 

  35. Whitfield, M., Grunau, R. V. E., & Holsti, L. (1997). Extremely premature (<800 g) schoolchildren: Multiple areas of hidden disability. Archives of Disease in Childhood, 77, F85–F90.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Lynn, L. N., Cuskelly, M., O’Callaghan, M. J., & Gray, P. H. (2011). Self-regulation: A new perspective on learning problems experienced by children born extremely preterm. Australian Journal of Educational and Developmental Psychology, 11, 1–10.

    Google Scholar 

  37. Hemmi, M. H., Wolke, D., & Schneider, S. (2011). Associations between problems with crying, sleeping, and/or feeding in infancy and long-term behavioural outcomes in childhood: A meta-analysis. Archives of Disease in Childhood, 96, 622–629.

    Article  PubMed  Google Scholar 

  38. Bilgin, A., & Wolke, D. (2016). Regulatory problems in very preterm and full-term infants over the first 18 months. Journal of Developmental and Behavioral Pediatrics, 37(4), 298–305.

    Article  PubMed  Google Scholar 

  39. Wolke, D., Schmid, G., Schreier, A., & Meyer, R. (2009). Crying and feeding problems in infancy and cognitive outcome in preschool children born at risk: A prospective population study. Journal of Developmental and Behavioral Pediatrics, 30, 226–238.

    Article  PubMed  Google Scholar 

  40. Arpi, E., & Ferrari, F. (2013). Preterm birth and behavior problems in infants and preschool-age children: A review of the recent literature. Developmental Medicine and Child Neurology, 55, 788–769.

    Article  PubMed  Google Scholar 

  41. Lowe, J., Woodward, B., & Papile, L. A. (2005). Emotional regulation and its impact on development in extremely low birth weight infants. Journal of Developmental and Behavioral Pediatrics, 26, 209–213.

    Article  PubMed  Google Scholar 

  42. Scott, M. N., Taylor, H. G., Fristad, M. A., et al. (2012). Behavior disorders in extremely preterm/extremely low birth weight children in kindergarten. Journal of Developmental and Behavioral Pediatrics, 33, 1–12.

    Article  Google Scholar 

  43. Miller, K. J. (2005). Executive functions. Pediatric Annals, 34, 311–317.

    Google Scholar 

  44. Powell, K. B., & Voeller, K. K. S. (2004). Prefrontal executive function syndromes in children. Journal of Child Neurology, 19, 785–797.

    Article  PubMed  Google Scholar 

  45. Anderson, P. J., Doyle, L. W., & Victorian Infant Collaborative Study Group. (2004). Executive functioning in school-aged children who were born very preterm or with extremely low birth weight in the 1990’s. Pediatrics, 114, 50–57.

    Article  PubMed  Google Scholar 

  46. Marlow, N., Hennessy, E. M., Bracewell, M. A., & Wolke, D. (2007). Motor and executive function at 6 years of age after extremely preterm birth. Pediatrics, 120, 793–803.

    Article  PubMed  Google Scholar 

  47. Aarnoudse-Moens, C. S. H., Weisglas-Kuperus, N., van Goudoever, B., & Oosterlaan, J. (2009). Meta-analysis of neurobehavioral outcomes in very preterm and/or very low birth weight children. Pediatrics, 124, 717–728.

    Article  PubMed  Google Scholar 

  48. Burnett, A. C., Scratch, S. E., Lee, K. J., et al. (2015). Executive function in adolescents born < 1000 g or < 28 weeks: A prospective cohort study. Pediatrics, 135, e826–e834.

    Article  PubMed  Google Scholar 

  49. Prock, L. A., & Rappaport, L. (2009). Attention and deficits of attention. In W. B. Carey, A. C. Crocker, W. L. Coleman, E. R. Elias, & H. M. Feldman (Eds.), Developmental-behavioral pediatrics (4th ed.). Philadelphia: Saunders Elsevier.

    Google Scholar 

  50. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington: American Psychiatric Association.

    Book  Google Scholar 

  51. Farooqi, A., Hagglof, B., Sedin, G., Gothefors, L., & Serenius, F. (2007). Mental health and social competencies of 10-to 12-year-old children born at 23 to 25 weeks of gestation in the 1990s: A Swedish national prospective follow-up study. Pediatrics, 120, 118–133.

    Article  PubMed  Google Scholar 

  52. Delobel-Ayoub, M., Arnaud, C., White-Koning, M., et al. (2009). Behavioral problems and cognitive performance at 5 years of age after very preterm birth: The EPIPAGE study. Pediatrics, 123, 1485–1492.

    Article  PubMed  Google Scholar 

  53. de Kieviet, J. F., van Elburg, R. M., Lafeber, H. N., & Oosterlaan, J. (2012). Attention problems of very preterm children compared with age-matched term controls at school-age. The Journal of Pediatrics, 161, 824–829.

    Article  PubMed  Google Scholar 

  54. Taylor, H. G., Margevicius, S., Schluchter, M., Andreias, L., & Hack, M. (2015). Persisting behavior problems in extremely low birth weight adolescents. Journal of Developmental and Behavioral Pediatrics, 36(3), 178–187.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Montagna, A., & Nosarti, C. (2016). Socio-emotional development following very preterm birth: Pathways to psychopathology. Frontiers in Psychology, 7, 23.

    Article  Google Scholar 

  56. Msall, M. E., & Park, J. J. (2008). The spectrum of behavioral outcomes after extreme prematurity: Regulatory, attention, social, and adaptive dimensions. Seminars in Perinatology, 32, 42–50.

    Article  PubMed  Google Scholar 

  57. Williamson, K. E., & Jakobson, L. S. (2014). Social perception in children born at very low birth weight and its relationship with social/behavioral outcomes. Journal of Child Psychology and Psychiatry, 55, 990–998.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Msall, M. E., Phelps, D. L., Hardy, R. J., Dobson, V., Quinn, G. E., Summers, C. G., & Tremont, M. R. (2004). Educational and social competencies at 8 years in children with threshold retinopathy of prematurity in the CRYO-ROP multicenter study. Pediatrics, 133, 790–799.

    Article  Google Scholar 

  59. Indredavik, M. S., Vik, T., Heyerdahl, S., Kulseng, S., Fayers, P., & Brubakk, A.-M. (2004). Psychiatric symptoms and disorders in adolescents with low birth weight. Archives of Disease in Childhood. Fetal and Neonatal Edition, 89, F445–F450.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Ek, U., Fernell, E., Jacobsen, L., & Gillberg, C. (1998). Relationship between blindness due to retinopathy of prematurity and autistic spectrum disorders: A population based study. Developmental Medicine and Child Neurology, 40, 297–301.

    PubMed  Google Scholar 

  61. Limperopoulos, C., Bassan, H., Sullivan, N. R., et al. (2008). Positive screening for autism in ex-preterm infants: Prevalence and risk factors. Pediatrics, 121, 758–765.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Johnson, S., Hollis, C., Kochhar, P., Hennessey, E., Wolke, D., & Marlow, N. (2010). Autism spectrum disorders in extremely preterm children. The Journal of Pediatrics, 156, 525–531.

    Article  PubMed  Google Scholar 

  63. Joseph, R. M., O’Shea, T. M., Allred, E. N., et al. (2017). Prevalence and associated features of autism spectrum disorder in extremely low gestational age newborns at age 10 years. Autism Research, 10(2), 224–232.

    Article  PubMed  Google Scholar 

  64. Barre, N., Morgan, A., Doyle, L. W., & Anderson, P. J. (2011). Language abilities in children who were very preterm and/or very low birth weight: A meta-analysis. The Journal of Pediatrics, 158, 766–774.

    Article  PubMed  Google Scholar 

  65. Putnick, D. L., Bornstein, M. H., Eryigit-Madzwamuse, S., & Wolke, D. (2017). Long-term stability of language performance in very preterm, moderate-late preterm, and term children. The Journal of Pediatrics, 181, 74–79.

    Article  PubMed  Google Scholar 

  66. Guarini, A., Marini, A., Savini, S., Alessandroni, R., Faldella, G., & Sansavini, A. (2016). Linguistic features in children born very preterm at preschool age. Developmental Medicine and Child Neurology, 58, 949–956.

    Article  PubMed  Google Scholar 

  67. Foster-Cohen, S. H., Friesen, M. D., Champion, P. R., & Woodward, L. J. (2010). High prevalence/low severity language delay in preschool children born very preterm. Journal of Developmental and Behavioral Pediatrics, 31, 658–667.

    Article  PubMed  Google Scholar 

  68. Foster-Cohen, S., Edgin, J. O., Champion, P. R., & Woodward, L. J. (2007). Early delayed language in very preterm infants: Evidence from the MacArthur-Bates CDI. Journal of Child Language, 34, 655–675.

    Article  PubMed  Google Scholar 

  69. Saigal, S., & Doyle, L. W. (2008). An overview of mortality and sequelae of preterm birth from infancy to adulthood. Lancet, 371, 261–269.

    Article  PubMed  Google Scholar 

  70. Robertson, C. M. T., Howarth, T. M., Bork, D. L. R., & Dinu, I. A. (2009). permanent bilateral sensory and neural hearing loss of children after neonatal intensive care because of extreme prematurity: A thirty year study. Pediatrics, 123, e797–e807.

    Article  PubMed  Google Scholar 

  71. Fellman, V., Kushnerenko, E., Mikkola, K., Ceponiene, R., Leipala, J., & Naatanen, R. (2004). Atypical auditory event-related potentials in preterm infants during the first year of life: A possible sign of cognitive dysfunction? Pediatric Research, 56, 291–297.

    Article  PubMed  Google Scholar 

  72. Mutch, L., Alberman, E., Hagberg, G., Kodama, K., & Perat, M. V. (1992). Cerebral palsy epidemiology: Where are we now and where are we going? Developmental Medicine and Child Neurology, 34, 547–551.

    Article  PubMed  Google Scholar 

  73. Ancel, P. Y., Livinec, F., Larroque, B., et al. (2006). Cerebral palsy among very preterm children in relation to gestational age and neonatal ultrasound abnormalities: The EPIPAGE cohort study. Pediatrics, 117, 828–836.

    Article  PubMed  Google Scholar 

  74. Roze, E., Van Braeckel, K. N. J. A., van der Veere, C. N., et al. (2009). Functional outcome at school age of preterm infants with periventricular hemorrhagic infarction. Pediatrics, 123, 1493–1500.

    Article  PubMed  Google Scholar 

  75. Sigurdardottir, S., Indredavik, M. S., Eiriksodottir, A., Einarsdottir, K., Gudmundsson, H. S., & Vik, T. (2010). Behavioural and emotional symptoms of preschool children with cerebral palsy: A population based study. Developmental Medicine and Child Neurology, 52, 1056–1061.

    Article  PubMed  Google Scholar 

  76. Drillien, C. M. (1972). Abnormal neurologic signs in the first year of life in low-birthweight infants: Possible prognostic significance. Developmental Medicine and Child Neurology, 14, 575–584.

    Article  PubMed  Google Scholar 

  77. Georgieff, M. K., & Bernbaum, J. C. (1986). Abnormal Shoulder girdle muscle tone in premature infants during their first 18 months of life. Pediatrics, 77, 664–669.

    PubMed  Google Scholar 

  78. deGroot, L., Hopkins, B., & Touwen, B. (1997). Motor asymmetries in preterm infants at 18 weeks corrected age and outcomes at 1 year. Early Human Development, 48, 35–46.

    Article  Google Scholar 

  79. Samson, J. F., & deGroot, L. (2001). Study of a group of extremely preterm infants (25-27 Weeks): How do they function at 1 year of age? Journal of Child Neurology, 16, 832–837.

    Article  Google Scholar 

  80. deGroot, L., Hopkins, B., & Touwen, B. (1995). Muscle power, sitting unsupported and trunk rotation in pre-term infants. Early Human Development, 43, 37–46.

    Article  Google Scholar 

  81. deGroot, L., deGroot, C. J., & Hopkins, B. (1997). An instrument to measure independent walking: Are there differences between preterm and fullterm infants? Journal of Child Neurology, 12, 37–41.

    Article  Google Scholar 

  82. Breslau, N., Chilcoat, E. O., Johnson, E. O., Andreski, P., & Lucia, V. C. (2000). Neurologic soft signs and low birthweight: Their association and neuropsychiatric implications. Biological Psychiatry, 47, 71–79.

    Article  PubMed  Google Scholar 

  83. Harmon, H. M., Taylor, G. H., Minich, N., Wilson-Costello, D., & Hack, M. (2015). Early school outcomes for extremely preterm infants with transient neurological abnormalities. Developmental Medicine and Child Neurology, 57, 865–871.

    Article  PubMed  PubMed Central  Google Scholar 

  84. Edwards, J., Berube, M., Erlandson, K., et al. (2011). Developmental coordination disorder in school-aged children born very preterm and/or at very low birth weight: A systematic review. Journal of Developmental and Behavioral Pediatrics, 32, 678–687.

    Article  PubMed  Google Scholar 

  85. Goyen, T.-A., & Lui, K. (2009). Developmental coordination disorder in “apparently normal” schoolchildren born extremely preterm. Archives of Disease in Childhood, 94, 298–302.

    Article  PubMed  Google Scholar 

  86. Kuppala, V. S., Tabangin, M., Haberman, B., Steichen, J., & Yolton, K. (2012). Current state of high-risk infant follow-up care in the United States: results of a national survey of academic follow up programs. Journal of Perinatology, 32, 293–298.

    Article  PubMed  Google Scholar 

  87. Church, P. T., Cavanagh, A., Lee, S. K., Shah, V. Academic challenges for preterm infants:Parent and educators’ perspectives. Manuscript in draft.

    Google Scholar 

  88. Johnson, S., Gilmore, C., Gallimore, I., Jaekel, J., & Wolke, D. (2015). The long-term consequences of preterm birth: What do teachers know? Developmental Medicine and Child Neurology, 57(6), 571–577.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Paige Terrien Church .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Church, P.T., Banihani, R., Luther, M., Maddalena, P., Asztalos, E. (2018). Premature Infants: The Behavioral Phenotype of the Preterm Survivor. In: Needelman, H., Jackson, B. (eds) Follow-Up for NICU Graduates. Springer, Cham. https://doi.org/10.1007/978-3-319-73275-6_6

Download citation

Publish with us

Policies and ethics