Title

Behavioral Deficits at 18-22 Months of Age Are Associated with Early Cerebellar Injury and Cognitive and Language Performance in Children Born Extremely Preterm

Authors

Andrea F. Duncan, University of Texas Health Science Center at Houston
Carla M. Bann, RTI International
Allison Dempsey, University of Texas Health Science Center at Houston
Myriam Peralta-Carcelen, The University of Alabama at Birmingham
Susan Hintz, Stanford University
Alan H. Jobe, University of Cincinnati
Michael S. Caplan, Pritzker School of Medicine
Abbot R. Laptook, Women and Infants Hospital of Rhode Island
Betty R. Vohr, Women and Infants Hospital of Rhode Island
William Oh, Women and Infants Hospital of Rhode Island
Angelita M. Hensman, Women and Infants Hospital of Rhode Island
Barbara Alksninis, Women and Infants Hospital of Rhode Island
Dawn Andrews, Women and Infants Hospital of Rhode Island
Kristen Angela, Women and Infants Hospital of Rhode Island
Susan Barnett, Women and Infants Hospital of Rhode Island
Bill Cashore, Women and Infants Hospital of Rhode Island
Melinda Caskey, Women and Infants Hospital of Rhode Island
Kim Francis, Women and Infants Hospital of Rhode Island
Dan Gingras, Women and Infants Hospital of Rhode Island
Katharine Johnson, Women and Infants Hospital of Rhode Island
Theresa M. Leach, Women and Infants Hospital of Rhode Island
Bonnie E. Stephens, Women and Infants Hospital of Rhode Island
Victoria E. Watson, Women and Infants Hospital of Rhode Island
Michele C. Walsh, University Hospitals Rainbow Babies & Children's Hospital
Avroy A. Fanaroff, University Hospitals Rainbow Babies & Children's Hospital
Nancy S. Newman, University Hospitals Rainbow Babies & Children's Hospital
Deanne E. Wilson-Costello, University Hospitals Rainbow Babies & Children's Hospital
Bonnie S. Siner, University Hospitals Rainbow Babies & Children's Hospital
Arlene Zadell, University Hospitals Rainbow Babies & Children's Hospital
Julie DiFiore, University Hospitals Rainbow Babies & Children's Hospital
Monika Bhola, University Hospitals Rainbow Babies & Children's Hospital
Harriet G. Friedman, University Hospitals Rainbow Babies & Children's Hospital
Gulgun Yalcinkaya, University Hospitals Rainbow Babies & Children's Hospital

Document Type

Journal Article

Publication Date

1-1-2019

Journal

Journal of Pediatrics

Volume

204

DOI

10.1016/j.jpeds.2018.08.059

Keywords

behavior; extremely preterm; neuroimaging

Abstract

© 2018 Elsevier Inc. Objective: To investigate associations in toddlers born extremely preterm (<28 weeks) between neonatal neuroimaging and 18- to 22-month developmental and behavioral outcomes. Study design: Cohort analysis from the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network Surfactant Positive Airway Pressure and Pulse Oximetry Trial Neuroimaging and Neurodevelopmental Outcomes Study of infants born extremely preterm. Subjects underwent cranial ultrasonography and near-term magnetic resonance imaging (MRI). At 18-22 months of corrected age, the assessment included the Brief Infant Toddler Social Emotional Assessment (BITSEA) Problem and Competence Scale scores and the Bayley Scales of Infant Development, Third Edition (Bayley-III). The BITSEA Problem Scale assesses dysregulation; the Competence Scale assesses social-emotional competence. We examined associations of Problem and Competence scores and positive screen rates with cranial ultrasonography and near-term MRI. Mean BITSEA and Bayley-III scores were compared using ANOVA and positive screen rates with the χ 2 test. We computed correlations between BITSEA and Bayley-III scores. Results: Of the 397 children, positive BITSEA screens were found in 34% for the Problem score and 26% for the Competence score. Presence of lesions on near-term MRI that included cerebellar lesions were significantly associated with lower BITSEA Competence but not with Problem scores; Competence scores were inversely related to the presence/significance of lesions. Positive screens on Competence scores and on both Competence and Problem scores were significantly associated with Bayley-III cognitive and language scores <85 (P <.001). Conclusions: Social–emotional competence contributes to deficits in cognitive and language development. Presence of injury on near-term MRI that includes cerebellar lesions is associated with later social–emotional competence and may be a useful predictor to guide early assessment and intervention. Trial registration: ClinicalTrials.gov: NCT00063063 and NCT00233324.

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