Maternal educational status at birth, maternal educational advancement, and neurocognitive outcomes at age 10 years among children born extremely preterm
Robert M Joseph, Thomas M O'Shea, Elizabeth N Allred, Tim Heeren, Karl K Kuban
Pediatr Res. 2017 Nov 22. doi: 10.1038/pr.2017.267
To determine if a key marker of SES, maternal ed, is associated with later neurocognitive and academic outcomes among children born EP. Results/Conclusion. Children of mothers in lowest ed stratum at birth more likely to score ≥2 SDs below norms on 17 of 18 tests administered. Children of mothers w/advanced ed (n=199) were at reduced risk for scoring ≥2 SDs on 15 of 18 measures, but significant on only 2 of 18 measures. Among EP children, SE disadvantage at birth is associated with poorer neurocog and academic outcomes at 10 yrs, independent of GA. Maternal ed advancement in child’s first 10 years of life is associated with modestly improved neurocog outcomes.
Neurodevelopment at Age 10 Years of Children Born <28 Weeks With Fetal Growth Restriction
Steven J Korzeniewski, Elizabeth N Allred, Robert M Joseph, Tim Heeren, Karl C K Kuban, T Michael O'Shea, Alan Leviton, ELGAN Study Investigators
Pediatrics. 2017 Nov;140(5). pii: e20170697.
We sought to evaluate the relationships between FGR & cognitive, academic, and adaptive behavior brain function at age 10 years. The 52 children whose birth weight z scores were <-2 had severe FGR, and the 113 whose birth weight z scores were between -2 and -1 had less severe FGR.
RESULTS/CONCLUSION: The more severe the growth restriction in utero, the lower the level of function on multiple cognitive and academic achievement assessments performed at age 10 years–children were also more likely than to have social awareness impairments, autistic mannerisms, ASD, language difficulty, and diminished social and psychosocial functioning.
Social Responsiveness Scale Assessment of the Preterm Behavioral Phenotype in 10-Year-Olds Born Extremely Preterm
Steven J Korzeniewski, Robert M Joseph, So Hyun Kim, Elizabeth N Allred, T Michael OʼShea, Alan Leviton, Karl C K Kuban, ELGAN Study Investigators
J Dev Behav Pediatr . Nov/Dec 2017;38(9):697-705.
OBJECTIVE: To evaluate correlates of high score on the SRS in 10-year-old children who were born EP and who did not meet criteria for ASD.
METHODS: After excluding 61 /ASD, children grouped by IQ < or ≥85; neurocognitive & other deficits compared w/SRS scores ≥65 and < 65.
RESULTS / CONCLUSION: Among children w/IQ ≥ 85, prevalence of SRS scores ≥65 was 16% (103/628); among children IQ < 85, it was 27% (40/148) > 4% based on normed population. Among children w/IQ ≥ 85, high SRS scores more often had deficits in attention, EF, language and communication, and more often had ADHD & emotional sxs (e.g., anxiety and depression) problems. High SRS scores characteristic of children w/intellectual, neurocognitive, language, communication & behavior/emotion regulation probs.
Academic Achievement Deficits and Their Neuropsychological Correlates in Children Born Extremely Preterm
Natacha Akshoomoff, Robert M Joseph, H Gerry Taylor, Elizabeth N Allred, Timothy Heeren, Thomas M OʼShea, Karl C K Kuban
J Dev Behav Pediatr. 2017 Oct;38(8):627-637.
OBJECTIVE: to examine risks associated with LDs in a large sample of children born EP.
RESULTS / CONCLUSION: risk of low math achievement scores (27%) was 1.5 times higher than risk of low reading achievement scores (17%). LD based on reading only (RD, 6.4% of sample), math only (MD, 16.2%), both reading and math (RD/MD, 8.3%), or no reading or math disabilities (No LD, 69.1%). The RD and MD groups had different patterns of neuropsychological impairment. ELGAN children had higher than expected rates of LD, particularly in mathematics, even after taking SES into consideration. Results indicate specific cognitive weaknesses that differ between EP children with RD and MD.
Cognitive functioning at age 10 years among children born extremely preterm: A latent profile approach
Timothy Heeren, Robert M Joseph, Elizabeth N Allred, Thomas M O'Shea, Alan Leviton, Karl C K Kuban
Pediatr Res. 2017 Oct;82(4):614-619.
BACKGROUND:School-age children born EP are more likely than term peers to have multiple neurocognitive limitations.
METHODS: Based on measures of IQ and EF, subgroups of EP children with common neurocognitive function are identified using LPA. Classification of neurocognitive function using IQ and EF is compared to a standard classification based on IQ .
RESULTS / CONCLUSION: LPA identified four neurocognitive profiles in EP children, with 34% of EP children classified normal, 41% low-normal, 17% moderately impaired, and 8% severely impaired. Impaired children exhibited global impairment across cognitive domains, while children in low-normal group tended to have impaired inhibition relative to their reasoning and working memory skills.Both IQ and EF assessments are needed when describing school-age outcome of EP children
Both antenatal and postnatal inflammation contribute information about the risk of brain damage in extremely preterm newborns
Diana Yanni, Steven J Korzeniewski, Elizabeth N Allred, Raina N Fichorova, T Michael O'Shea, Karl Kuban, Olaf Dammann, Alan Leviton
Pediatr Res. 2017 Oct;82(4):691-696. doi: 10.1038/pr.2017.128. Epub 2017 Jun 21.
BACKGROUND Preterm newborns exposed to IU inflammation are at ▲risk of neurodevelopmental disorders. We hypothesized that adverse outcomes more strongly associated with combination of antenatal and postnatal inflammation than either alone.
RESULTS risk of WM damage increased when placental inflammation followed by elevation of CRP or ICAM-1. We found same for spastic CP when placental inflammation followed by elevation of TNF-α or IL-8. Presence of both placental inflammation & ▲ levels of IL-6, TNF-α, or ICAM-1 associated with microcephaly risk . CONCLUSION Compared to single hit, two inflammatory hits associated with stronger risk for abnormal HUS, spastic cerebral palsy, and microcephaly at 2 years.
Systemic Inflammation during the First Postnatal Month and the Risk of Attention Deficit Hyperactivity Disorder Characteristics among 10 year-old Children Born Extremely Preterm
Elizabeth N Allred, Olaf Dammann, Raina N Fichorova, Stephen R Hooper, Scott J Hunter, Robert M Joseph, Karl Kuban, Alan Leviton, Thomas Michael O'Shea, Megan N Scott, ELGAN Study ADHD symptoms writing group for the ELGAN Study Investigators
J Neuroimmune Pharmacol. 2017 Sep;12:531-543.
Abstract 151 children with ADHD behaviors were identified by parent report, while 128 children were identified by teacher report. Top-quartile concentrations of IL-6R, TNF-α, IL-8, VEGF, VEFG-R1, and VEGF-R2 on multiple days were associated with increased risk of ADHD symptoms as assessed by a teacher. Some of this increased risk was modulated by top-quartile concentrations of IL-6R, RANTES, EPO, NT-4, BDNF, bFGF, IGF-1, PIGF, Ang-1, and Ang-2.
Maternal obesity and attention-related symptoms in the preterm offspring
Jelske W van der Burg, Elizabeth T Jensen, Margot van de Bor, Robert M Joseph, T Michael O'Shea, Karl Kuban, Elizabeth N Allred, Megan Scott, Scott Hunter, Stephen R Hooper, Olaf Dammann, Alan Leviton
Early Hum Dev. 2017 Aug 17;115:9-15
AIM: estimate risk of attention problems at age 10 yrs in children born EP to overweight and obese women .
METHODS: 764 children had IQ≥70 at age 10years when parents and teachers completed CSI-4 that included items about ADHD.
RESULTS / CONCLUSION: Children at increased risk of parent-identified ADHD if mother overweight (odds ratio (OR)=1.9; 95% CI: 1.1, 3.3), or obese (OR=2.3; 95% CI: 1.4, 3.9). No increased risk of teacher-identified ADHD if mother overweight (OR=1.0; 95% CI: 0.6, 1.8), or obese (OR=1.0; 95% CI: 0.6, 1.6). Maternal overweight and obesity are associated with increased risk of parent-identified ADHD characteristics at 10years of age in children born EP.
Cumulative Incidence of Seizures and Epilepsy in Ten-Year-Old Children Born Before 28 Weeks’ Gestation
Laurie M Douglass, Timothy C Heeren, Carl E Stafstrom, William DeBassio, Elizabeth N Allred, Alan Leviton, T Michael O'Shea, Deborah Hirtz, Julie Rollins, Karl Kuban
Pediatr Neurol. 2017 Aug;73:13-19
OBJECTIVE: We evaluated incidence of seizures and epilepsy in first decade of life among children born extremely premature.
RESULTS: By 10 yrs, 12.2% had ≥ 1 seizure, 7.6% had epilepsy, 3.2% had seizure with fever, and 1.3% had a single, unprovoked seizure; incidence increased with ▼GA. In > 75%, seizurs onset was > one year of age. Sz incidence comparable in sexes. ⅔ had other neurological disorders. ⅓ with epilepsy not recorded on questionnaire.
SIGNIFICANCE: Incidence of epilepsy through ten yrs among children born extremely preterm is ~7-14-fold higher than general pediatric pop. Szs under-recognized.
Neurocognitive Outcomes at 10 Years of Age in Extremely Preterm Newborns with Late-Onset Bacteremia
H Reeve Bright, Kikelomo Babata, Elizabeth N Allred, Carmina Erdei, Karl C K Kuban, Robert M Joseph, T Michael O'Shea, Alan Leviton, Olaf Dammann, ELGAN Study Investigators
J Pediatr. 2017 Aug;187:43-49.
OBJECTIVE: To evaluate difference in 10-year neurocognitive outcomes between E:LGANS with/without suspected or confirmed bacteremia .
STUDY DESIGN: Definite (culture-positive) late-onset bacteremia in postnatal weeks 2-4 was identified in 223 children, and 129 children had suspected bacteremia.
RESULTS / CONCLUSIONS: Infants with lowest GA and B Wt z-score had highest prevalence of definite and suspected late-onset bacteremia. Definite bacteremia associated with worse performance w/IQ, language, academic achievement, and EF. Adjustment for low IQ attenuated associations between bacteremia and dysfunctions at 10 years. Children with suspected bacteremia did not differ from no bacteremia.