Long-term outcomes of preterm birth: risk and resilience

Every year on average 15 million babies are born preterm (birth before 37 weeks of gestation). Although the majority of these babies can be saved with current interventions they still experience lifelong difficulties. Preterm birth and related risk factors are critical indicators of developmental outcomes and long-term wellbeing. While it is well-established that these risk factors have significant impact on developmental outcomes during childhood, there is considerable uncertainty on their long-term influence on health and wellbeing later in life.

A recently completed study on preterm birth examined its impact on psycho-social and cognitive (for example, attention, IQ and language) outcomes at different stages of development using datasets, such as the Bavarian Longitudinal Study and the Growth in At-Risk Infants Study.

The aims of this project were to:

> examine very preterm (gestational age at birth > investigate whether there are differences in attachment security and disorganisation between (VP/VLBW) and full-term born children; and whether the pathways to disorganised attachment differ between them at the age of 18 months.
> investigate the impact of gestational age at birth and SGA, birth on child attention problems at six and eight years of age.
> test if adverse effects of preterm birth on attention regulation and academic achievement are mediated by children’s early delay gratification abilities at age of eight.
> examine general intelligence (IQ) and executive functioning (EF) of adults born VP/VLBW in comparison to term controls at 26 years.

> VP/VLBW birth is a significant risk for a global withdrawn personality, as indicated by being less socially engaged (introversion), low in taking risks, poor in communication (autistic features) and easily worried (neuroticism).
> A third of VP/VLBW children are found to have disorganised attachment type.
> A non-linear relationship was found between attention and gestational age at birth; whereas being small for gestational age at birth was an additional risk factor for poorer attention in childhood across the full spectrum of gestation.
> The impact of preterm birth on attention problems was partially mediated by children’s ability to delay instant gratification.
> Cognitive problems were observed in VP/VLBW born adults despite many receiving special education support; and low family socio-economic status had an additive adverse effect.


The results of this study confirm the significant impact of preterm birth on individuals’ psycho-social and cognitive outcomes longitudinally. This study also shows the additive effect of low socio-economic status on development of preterm children. This confirms that inequalities are stark not only in survival rates of preterm neonates but also in their wellbeing and adjustment lifelong. Further research will aim to understand in detail the impact of social disadvantage on preterm children’s development taking a resilience perspective, such as exploring the ways to tackle some of the risk factors. These studies will inform resilience building practices for individuals born preterm.

Further findings

Suna Eryigit-Madzwamuse collaborated with Diane Putnick, Marc Bornstein and Dieter Wolke on an investigation into whether children born very preterm, moderate-late preterm, and term differ in their average level and individual-difference stability in language performance over time.

Language was assessed at five and 20 months and four, six, and eight years of age in 204 very preterm (<32 weeks' gestation), 276 moderate-late preterm (32-36 weeks' gestation), and 268 term (37-41 weeks' gestation) children from the Bavarian Longitudinal Study.

Very preterm children consistently performed worse than term-born children, and moderate-late preterm children scored in between. Language performance was stable from five months through eight years in all gestation groups combined, and stability increased between each succeeding wave. Stability was stronger between five months and four years in very preterm than moderate-late preterm and term groups, but this differential stability attenuated when covariates (child nonverbal intelligence and family socioeconomic status) were controlled.

The team concluded that preterm children, even moderate-late preterm, are at risk for poorer language performance than term-born children. Because individual differences in language performance are increasingly stable from 20 months to eight years in all gestation groups, pediatricians who attend to preterm children and observe language delays should refer them to language intervention at the earliest age seen.

Outputs

Putnick, D., Bornstein, MH., Eryigit-Madzwamuse, S and Wolke, D. (2016) Long-term stability of language performance in very preterm, moderate-late preterm and term children. Journal of Pediatrics,
Eryigit-Madzwamuse, S., Strauss, V., Baumann, N., Bartmann, P., Wolke, D. (accepted) Personality of adults who were born extremely preterm. Archives of Disease in Childhood - Fetal and Neonatal Edition.
Eryigit-Madzwamuse, S., Baumann, N., Jaekel, J., Bartmann, P., Wolke, D. (in press) Neuro-cognitive performance of very preterm or very low birth weight adults at 26 years. Journal of Child Psychology and Psychiatry.
Eryigit-Madzwamuse, S. & Wolke, D. (2015) Attention problems in relation to gestational age at birth and smallness for gestational age. Early Human Development, 91, 131-8.
Wolke, D. Eryigit-Madzwamuse, S., & Gutbrod, T. (2014) Very preterm/very low birthweight infants' attachment: Infant and maternal characteristics. Archives of Disease in Childhood - Fetal and Neonatal Edition, 99, f70-75.
Wolke, D. Chernove J., Eryigit-Madzwamuse, S., Samara, M., Zwierzynska, K., & Petrou, S. (2013) Self & parent perspectives on health related quality of life of adolescents born very preterm. Journal of Pediatrics, 163, 1020-6.
Eryigit-Madzwamuse, S. & Wolke, D. (2013, March) Attention: Gestational age, mode of delivery and types of smallness for gestational age. Invited talk at the Lifespan, Health and Wellbeing Research Group meeting, University of Warwick, Coventry, UK.
Eryigit-Madzwamuse, S. (2013, April) Biological risks of development in multiple domains Invited talk at the external seminar of Human Development and Family Studies, Auburn University, Auburn, AL.
Eryigit-Madzwamuse, S., Wolke, D., Baumann, N., & Bartmann, P. (2014, Oct) Autistic features, personality and risk taking of a very preterm and/or very low birth weight community sample of adults. Poster presented at the annual meeting of the European Society for Paediatric Research, Barcelona, Spain.
Jaekel, J., Eryigit-Madzwamuse, S., Wolke, D. (2014, Oct) Early delay gratification abilities mediate effects of preterm birth on attention regulation and academic achievement at age 8 years. Poster presented at the annual meeting of the European Society for Paediatric Research, Barcelona, Spain.
Eryigit-Madzwamuse, S. (2014 June) Cognitive profile of very preterm and/or very low birth weight adults: Bavarian Longitudinal Study. Paper presented at the annual conference of the World Association of Infant Mental Health, Edinburgh, UK.
Eryigit-Madzwamuse, S. & Wolke, D. (2013,October) Gestational age and in-uterine growth restriction predict attention problems at school age. Poster presented at the annual meeting of the European Society for Paediatric Research, Porto, Portugal.