Elsevier

Clinics in Perinatology

Volume 45, Issue 3, September 2018, Pages 485-500
Clinics in Perinatology

Biological and Social Influences on the Neurodevelopmental Outcomes of Preterm Infants

https://doi.org/10.1016/j.clp.2018.05.005Get rights and content

Section snippets

Key points

  • Early biological factors (eg, brain injury and retinopathy of prematurity) and treatments (eg, postnatal corticosteroids and early surgery) are markers of later sensory and motor impairments.

  • Cognitive and academic difficulties seem to be susceptible to some biological and social variables, but these influences vary across development.

  • Behavior and mental health outcomes are not consistently associated with perinatal variables, but greater relationships exist with earlier behavioral difficulties

Neurosensory outcomes

Perhaps the most commonly reported outcome in studies of prematurity is a composite outcome of neurosensory impairment, also called neurodevelopmental impairment. Neurosensory impairments generally include cerebral palsy (CP), impaired vision, impaired hearing, and developmental delay in younger children or intellectual impairment in older children. Neurosensory impairments are generally categorized according the degree of impairment observed (eg, mild/moderate/severe). Permanent motor and

Cognitive and academic outcomes

Cognitive deficits are the most commonly identified difficulties after preterm birth. In toddlerhood, early cognitive and language abilities are now primarily assessed using the Bayley Scales of Infant and Toddler Development–Third Edition.37 For older samples assessed with the second edition of this test, cognitive and language abilities at this age were measured with a single index (Mental Developmental Index) and, thus, could not be distinguished from each other. In older children, many

Behavior and mental health

Difficulties in behavior and mental health are widely reported among preterm cohorts, with anxiety, attention problems, and peer/social difficulties, as well as clinical diagnoses of attention deficit and hyperactivity disorder (ADHD; predominantly the inattentive subtype) and autism spectrum disorder (ASD) highlighted.54 A range of methodologic issues is relevant to this area of literature. Most studies examining behavior and mental health have used questionnaires, targeting either overall

Future directions

Biological and social influences are associated with outcomes after preterm birth, but more work is needed to characterize the relative importance of and interplay between these influences for different outcomes throughout development. For instance, although it is beyond the scope of this review, prenatal exposures to maternal stress or other biological challenges may program long-term responses to the environment. Gene–environment interaction studies are also a potentially fruitful avenue for

Summary

Ultimately, greater knowledge of the contributions of biological and social influences to outcomes for preterm children will enhance our capacity to identify and intervene to support children at high developmental risk.

Best Practices

What is the current practice?

  1. Children born very preterm and very low birthweight are at high risk of sensory, cognitive, academic, and behavioral difficulties, but these risks are shaped by biological and social influences.

What changes in current practice are likely to improve outcomes?
  1. Major Recommendations

    • Increased reporting of relationships of biological

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    Disclosure Statement: The authors have no conflicts of interests to disclose.

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