Kristian Sommerfelt’s research while affiliated with Haukeland University Hospital and other places

Objective: To investigate development and predictors of mental health problems from five to eleven years of age in children born extremely preterm (EP). Method: In a national Norwegian cohort of children born before a gestational age of 28 weeks or with a birthweight <1000 g mental health was assessed by parents at five and eleven years of age using The Strengths and Difficulties Questionnaire. A Total Difficulties Score ≥ 90th percentile (TDS90) for a reference group was used as a measure of a mental health problem. Of 338 eligible EP children, 162 (48%) attended at both ages. Results: The rate of TDS90 was 52 (32%) at five and 37 (23%) at eleven years of age (p = 0.025). Of the 52 children with TDS90 at five years, 25 had TDS90 at eleven years of age, and of 37 children with TDS90 at eleven, 25 had TDS90 at five years of age. Mental health problems and an IQ of 70-84 at five years were independent predictors of TDS90 at eleven years of age. Conclusion: The rate of mental health problems decreased from five to eleven years, but individual stability was moderate. Mental health problems and intellectual function in the lower normal range at preschool age were independent predictors of later mental health problems.

The aims were to investigate mental health problems with the Strength and Difficulties Questionnaire (SDQ) in children born extremely preterm/extremely low birth weight (EP/ELBW) without severe disabilities compared to controls, and to identify peri-, or neonatal factors possibly predicting later mental health problems. A national Norwegian cohort of 11-year-old EP/ELBW children, excluding those with intellectual disabilities, non-ambulatory cerebral palsy, blindness and/or deafness, was assessed. Parents and teachers completed the SDQ. Mean scores and scores ≥90th percentile for the control group, combined (parent and/or teacher reporting the child ≥90th percentile), and pervasive ratings (both parent and teacher reporting the child ≥90th percentile) were presented. The controls consisted of an unselected population of all 11-year-old children born in 1995 who attended public or private schools in Bergen. Of the eligible children, 216 (64%) EP/ELBW and 1882 (61%) control children participated. The EP/ELBW children had significantly higher scores and/or increased risk of parent, teacher, combined, and pervasive rated hyperactivity/inattention, emotional-, and peer problems (OR 2.1-6.3). Only parents reported the EP/ELBW children to be at an increased risk of conduct problems (OR 1.6, 95% CI 1.1-2.6). Only low maternal education at birth was significantly associated with mental health problems at 11 years of age (OR 2.5, 95% CI 1.2-5.4). EP/ELBW children without severe disabilities had increased risk of symptoms of hyperactivity/inattention, emotional-, and peer problems. None of the peri- or neonatal factors were significantly associated with later mental health problems, except for low maternal education.

Objective: To describe the prevalence and gender characteristics of mental health problems in extremely preterm/extremely low birth weight (EP/ELBW) children without intellectual disabilities, blindness, deafness, or severe cerebral palsy compared with a reference group at 11 years of age. Methods: In a national cohort of EP/ELBW children, mental health was assessed by parental and teacher report by using the Autism Spectrum Screening Questionnaire, the Swanson, Noland, and Pelham Questionnaire IV (attention-deficit/hyperactivity disorder), the Screen for Child Anxiety Related Emotional Disorders, symptoms of obsessive-compulsive disorder (OCD), and a total difficulties score from the Strength and Difficulties Questionnaire. Pervasive rating was defined as both parent and teacher scoring the child ≥95th percentile (≥90th percentile for total difficulties score) of the reference group, which was the population-based Bergen Child Study. Results: Of eligible children, 216 (64%) EP/ELBW and 1882 (61%) reference children participated. EP/ELBW children were at significantly increased risk of pervasive rated symptoms of autism (odds ratio 4.3, 95% confidence interval 2.0-9.3), inattention (8.3, 4.4-15), anxiety (2.3, 1.4-3.7), OCD (2.6, 1.4-3.7), and ≥90th percentile for total difficulties score (4.9, 2.9-8.2). Reported by either parents or teachers, 54% of the EP/ELBW and 21% of the reference children had ≥1 mental health problem (odds ratio 4.5, 95% confidence interval 3.3-6.1). There were no significant interactions between EP/ELBW and gender in mental health outcomes. Conclusions: EP/ELBW children without severe disabilities had increased risk of symptoms of autism, inattention, anxiety, and OCD. Gender differences were comparable to the reference group.

Objective To describe the prevalence of mental health problems, and symptoms of Autism Spectrum Disorders (ASD), Attention Deficit/Hyperactivity Disorder (ADHD), Anxiety and Obsessive Compulsive Disorder (OCD) at 11 years of age in extremely preterm/extreme low birth weight (EP/ELBW) children without mental retardation, blindness, deafness, or severe cerebral palsy compared to a reference Group. Methods In a national Norwegian cohort with gestational age 22–27 weeks or birth weight 500–999 g, mental health was assessed by parents and teachers using The Strengths and Difficulties Questionnaire (SDQ), The Autism Spectrum Screening Questionnaire (ASSQ), The Swanson, Noland, and Pelham Questionnaire IV (SNAP IV), The Screen for Child Anxiety Related Emotional Disorders (SCARED) and symptoms of obsessive-compulsive disorder (OCD). Pervasive rating was defined as both parent and teacher reported problem at or above the 95th percentile for the reference group, except for SDQ with a 90th percentile. The reference group was children from the longitudinal population based Bergen Child Study in Norway. Results Of the 338 eligible EP/ELBW children, 216 (64%) attended the study while 1880 (61%) of reference children attended. Thirteen percent of the EP/ELBW children compared to 3% of the reference group had a pervasive rated indication of psychiatric disorder according to SDQ (OR: 4.9, 95% CI; 2.9–8.2). EP/ELBW children were at significantly increased risk of pervasive rated ASD symptomatology (EP/ELBW: 6% References: 1%, OR: 4.3, 95% CI; 2.0–9.3), OCD symptoms (OR: 2.6, 95% CI; 1.4–3.7), Anxiety symptoms (OR: 2.3, 95% CI; 1.4–3.7), and ADHD inattention symptomatology (EP/ELBW: 11% References: 1%, OR: 8.3, 95% CI; 4.4–15). Symptoms of ADHD hyperactivity did not reach significant level. Conclusion Extremely premature children without severe neurodevelopmental deficits had increased risk of mental health problems in general and, specifically increased risk of symptomatology of ADHD inattention, ASD, OCD, and Anxiety.

AimFetoplacental Doppler abnormalities have been associated with increased neonatal mortality and morbidity. This study evaluated the associations between prenatal Doppler assessments and neonatal mortality and morbidity in premature infants born small for gestational age or after pre-eclampsia.Methods This was a population-based study of infants born alive at 220 - 336 weeks of gestation, a birth weight <10th percentile for gestational age and, or maternal pre-eclampsia. Doppler assessments of the umbilical artery, middle cerebral artery and ductus venosus were evaluated in 127, 125 and 95 cases respectively. Circulatory compromise was defined as absent or reversed end-diastolic velocity in the umbilical artery (AREDF), middle cerebral artery pulsatility index <2.5 percentile for gestational age and ductus venosus pulsatility index for veins >97.5 percentile.ResultsAREDF was present in 28% of the infants. This was associated with increased frequencies of neonatal sepsis and necrotising enterocolitis after adjusting for gestational age. Abnormal ductus venosus pulsatility index for veins was associated with increased risk of neonatal sepsis, but only in combination with AREDF. These associations were only present when gestational age was <28 weeks.ConclusionAREDF was associated with increased neonatal morbidity in premature infants born small for gestational age or after pre-eclampsia.This article is protected by copyright. All rights reserved.

ADHD is more common in children born preterm than at term. The purpose of the study was to examine if, and to what extent, ADHD symptoms are associated with minor neurodevelopmental impairments (NDI) in extremely preterm children. In a national population-based cohort with gestational age 22-27 weeks or birth weight <1,000 g assessed at 5 years of age, scores on Yale Children's Inventory (YCI) scales (seven scales) were related to normal functions vs. NDI defined as mild impairments in cognitive function (IQ 70-84), motor function (Movement Assessment Battery for children score > the 95th percentile or freely ambulatory cerebral palsy), vision (correctable), and hearing (no hearing aid). YCI was completed for 213 of 258 eligible children (83 %). Children with minor NDIs (n = 98) had significantly higher scores (more ADHD symptoms) than those without NDI (n = 115) on the YCI scales of Attention, Tractability, Adaptability and Total score. Increasing numbers of minor NDIs were associated with higher mean YCI scores. In multivariate analysis only decreased hearing, IQ, and male gender were significantly associated with scores on the Attention scale. Thirty-three children (16 %) had scores >3 on the Attention scale (probably ADHD), and the proportion was significantly higher for those with mild NDIs compared to those without (Odds ratio = 2.7, 95 % CI 1.3-6.0). Children born extremely preterm with minor NDIs were more likely to have ADHD symptoms than those with no NDI, and increasing number of minor NDIs were associated with more ADHD symptoms.

Aim: To investigate whether absent or reversed end-diastolic flow in the umbilical artery (AREDF) is associated with neonatal mortality, morbidity or long-term neurocognitive outcome in extremely preterm infants exposed to preeclampsia or intrauterine growth restriction. Methods: Prenatal Doppler data were retrospectively collected for liveborn infants with gestational age (GA) <28 weeks or birth weight (BW) <1000 g, born small for gestational age (SGA- BW <5th percentile for GA) or of mothers with preeclampsia at the four largest university hospitals in Norway during 1999-2000. Neonatal mortality and morbidities, cerebral palsy (CP) and IQ at 5 years of age were compared for infants with or without AREDF. Results: Of 260 infants, 84 were eligible and 71 of them had sufficient Doppler data. Of these, 38 (54%) had AREDF. Of 33 infants born <28 weeks, 7 of 19 (37%) with AREDF and none of 14 without AREDF had severe cerebral haemorrhage (SCH) (p = 0.01). AREDF was not significantly associated with mortality, other NICU morbidities, CP or reduced IQ. For the 38 infants with GA ≥28 weeks, AREDF (19 of 38) was not associated with adverse outcomes. Conclusion: Absent or reversed end-diastolic flow in the umbilical artery (AREDF) was associated with increased risk of SCH in extremely preterm infants (GA <28 weeks).

To examine the predictive value of early assessments on developmental outcome at 5 years in children born extremely preterm. This is a prospective observational study of all infants born in Norway in 1999-2000 with gestational age (GA) <28 weeks or birth weight (BW) <1000 g. At 2 years of age, paediatricians assessed mental and motor development from milestones. At 5 years, parents completed questionnaires on development and professional support before cognitive function was assessed with Wechsler Preschool and Primary Scale of Intelligence-Revised (WPPSI-R) and motor function with the Movement Assessment Battery for children (ABC test). Twenty-six of 373 (7%) children had cerebral palsy at 2 and 29 of 306 (9%) children at 5 years. Of children without major impairments, 51% (95% CI 35-67) of those with and 22% (95% CI 16-28) without mental delay at 2 years had IQ <85 at 5 years, and 36% (95% CI 20-53 with and 16% (95% CI 11-21) without motor delay at 2 years had an ABC score >95th percentile (poor function). Approximately half of those without major impairments but IQ <85 or ABC score >95th percentile had received support or follow-up beyond routine primary care. Previous assessments had limited value in predicting cognitive and motor function at 5 years in these extremely preterm children without major impairments.

To examine the prevalence of neurodevelopmental disability and the predictive value of pre-, peri-, and postnatal data on neurologic, sensory, cognitive, and motor function in children born extremely preterm. This was a prospective observational study of all infants born in Norway between 1999 and 2000 with gestational ages between 22 and 27 weeks or birth weights between 500 and 999 g. Cognitive function was assessed with the Wechsler Preschool and Primary Scale of Intelligence-Revised, motor function with the Movement Assessment Battery for Children, and severity of cerebral palsy with the Gross Motor Function Classification for Cerebral Palsy. Disabilities were described as mild, moderate, or severe. Of 371 eligible children, 306 (82%) were examined at a mean (SD) age of 5 years and 10 (4) months. For gestational age less than 28 weeks (n = 239), 26 (11%) children had cerebral palsy alone (n = 21) or in combination with blindness (n = 3) or deafness (n = 2); 1 was blind and 1 was deaf. Of the remaining children, the mean full-scale IQ was 94 ± 15, and significant predictors were (values given as the difference in IQ points [95% confidence intervals]) high maternal education (9.6 [5.7-13.4]), preeclampsia (-7.7 [-12.7 to -2.7]), and retinopathy of prematurity higher than grade 2 (-17.5 [-27.1 to -8.0]). Movement Assessment Battery for Children scores were positively associated with gestational age and prenatal steroids and negatively associated with being small for gestational age, male gender, and having retinopathy of prematurity. Moderate to severe neurodevelopmental disability was more common for gestational ages 25 weeks or less (28 of 87 children) than for 26 to 27 weeks (12 of 152 children; P < .001) and 28 weeks or more (7 of 67 children; P = .001). The outcome was poorer for children with gestational ages of 25 weeks or less compared with those with gestational ages between 26 and 27 weeks. For those without cerebral palsy, blindness, or deafness, however, gestational age had a limited association with cognitive and motor function.

Extreme prematurity carries a high risk of neurosensory disability. Examine which information obtained pre-, peri- and postnatally may be predictive of neurosensory disabilities at 2 years of age. Prospective observational study of all infants born in Norway in 1999 and 2000 with gestational age (GA) 22-27 completed weeks or birth weight (BW) of 500-999 g. Incidence of neurosensory disabilities. Of 373 surviving children, 30 (8%) had major neurosensory disabilities (26 CP, 6 blind, 3 deaf), and a further 46 (12%) had minor visual or hearing disabilities. The rate of major neurosensory disabilities was 19 of 99 (19%) for children with GA 23-25 vs. 8 of 189 (4%) for GA 26-27 weeks (p<0.001). In a multivariable model, only morbidities detected in the neonatal intensive care unit (NICU) were associated with major neurosensory disabilities; adjusted odds ratios (95% confidence intervals) were 68.6 (18.7, 252.2) for major abnormalities on cerebral ultrasound, 6.8 (1.7, 27.4) for retinopathy of prematurity (ROP) grade>2, 3.2 (1.0, 9.7) for ROP grade 1-2, 6.5 (1.9, 22.3) for prolonged use (> or = 21 days) of steroid treatment for lung disease and 3.1 (1.0, 9.4) for clinical chorioamnionitis. The visual outcome was strongly related to the degree of ROP (p<0.001), and all who had a normal hearing screen in the NICU had normal hearing at 2 years. NICU morbidities, rather than GA or intrauterine growth are the significant predictors of major neurosensory disabilities among extreme prematurity surviving to discharge from the NICU.