Article

Psychiatric Disorders in Extremely Preterm Children: Longitudinal Finding at Age 11 Years in the EPICure Study

Institute for Women's Health, University College London and the School of Clinical Sciences, University of Nottingham, UK.
Journal of the American Academy of Child and Adolescent Psychiatry (Impact Factor: 7.26). 05/2010; 49(5):453-63.e1. DOI: 10.1016/j.jaac.2010.02.002
Source: PubMed

ABSTRACT

To investigate the prevalence and risk factors for psychiatric disorders in extremely preterm children.
All babies born <26 weeks gestation in the United Kingdom and Ireland from March through December 1995 were recruited to the EPICure Study. Of 307 survivors at 11 years of age, 219 (71%) were assessed alongside 153 term-born classmates. Parents completed a structured psychiatric interview about their child, and teachers completed a corresponding questionnaire from which DSM-IV diagnoses were assigned for 219 (100%) extremely preterm children and 152 (99%) classmates. An IQ test and a physical evaluation were also administered. Longitudinal data were available for extremely preterm children.
Extremely preterm children were more than three times more likely to have a psychiatric disorder than classmates (23% vs. 9%; odds ratio [OR] = 3.2; 95% confidence interval [CI] = 1.7, 6.2). Risk was significantly increased for: attention-deficit/hyperactivity disorder (ADHD; 11.5% vs. 2.9%; OR = 4.3; CI = 1.5 to 13.0), with increased risk for ADHD inattentive subtype (OR = 10.5; CI = 1.4 to 81.1) but not ADHD combined subtype (OR = 2.1; CI = 0.5 to 7.9); emotional disorders (9.0% vs. 2.1%; OR = 4.6; CI = 1.3 to 15.9), with increased risk for anxiety disorders (OR = 3.5; CI = 1.0 to 12.4); and autism spectrum disorders (8.0% vs. 0%; p = .000). Psychiatric disorders were significantly associated with cognitive impairment (OR = 3.5; CI = 1.8 to 6.4). Parent-reported behavioral problems at 2.5 and 6 years were independent predictors of psychiatric disorders at 11 years.
Extremely preterm children are at increased risk for ADHD, emotional disorders, and autism spectrum disorders at 11 years of age. The mechanism of association with psychiatric disorder may include both cognitive impairment and early traumatic experiences that have an impact on both child and parent. Early screening for cognitive and behavioral problems may identify those at greatest risk.

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    • "These ADHD problems were predominantly of the inattentive (ADHD-IA) and combined (ADHD-C) subtypes consistent with previous reports of VP/ VLBW children (Elgen, Sommerfelt, & Markestad, 2002). Specifically, previous studies reported a 15%–23% prevalence of ADHD in VP/VLBW children (Elgen et al., 2002; Johnson et al., 2010) similar to the 21.9% prevalence of childhood ADHD in our VP/VLBW sample, which equates to a 2–3 fold increased risk (Bhutta et al., 2002). Furthermore , the 7%–23% prevalence of ADHD (Johnson & Wolke, 2013) in VLBW adolescents previously reported is fairly consistent with our VP/VLBW adult sample's 9.8% prevalence. "
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    • "under 750 g) had moderate to severe neurocognitive disability, and longer follow-up studies (up to age 11) documented an increased risk of psychiatric disorders compared with term-born classmates (Johnson et al. 2010a). Although the EPICure study included a small number of infants born in Ireland in 1995, to protect anonymity, none of the Irish data has been presented separately and therefore we do not have any data on the MH outcomes of children growing up in Ireland. "
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