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Journal of Pediatrics, The

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Girls and Boys Born before 28 Weeks Gestation: Risks of Cognitive, Behavioral, and Neurologic Outcomes at Age 10 Years - 25/05/16

Doi : 10.1016/j.jpeds.2016.02.048 
Karl C.K. Kuban, MD, SMEpi 1, ⁎ , Robert M. Joseph, PhD 2, Thomas M. O'Shea, MD 3, Elizabeth N. Allred, MS 4, 5, Timothy Heeren, PhD 6, Laurie Douglass, MD 1, Carl E. Stafstrom, MD, PhD 7, Hernan Jara, PhD 8, Jean A. Frazier, MD 9, Deborah Hirtz, MD 10, Alan Leviton, MD 4, 5
on behalf of the

Extremely Low Gestational Age Newborn (ELGAN) Study Investigators∗

  List of additional ELGAN Study Investigators is available at www.jpeds.com (Appendix).
Janice Ware, PhD, Taryn Coster, BA, Brandi Hanson, PsyD, Rachel Wilson, PhD, Kirsten McGhee, PhD, Patricia Lee, PhD, Aimee Asgarian, PhD, Anjali Sadhwani, PhD, Ellen Perrin, MD, Emily Neger, MA, Kathryn Mattern, BA, Jenifer Walkowiak, PhD, Susan Barron, PhD, Bhavesh Shah, MD, Rachana Singh, MD, MS, Anne Smith, PhD, Deborah Klein, BSN, RN, Susan McQuiston, PhD, Lauren Venuti, BA, Beth Powers, RN, Ann Foley, Ed M, Brian Dessureau, PhD, Molly Wood, PhD, Jill Damon-Minow, PsyD, Richard Ehrenkranz, MD, Jennifer Benjamin, MD, Elaine Romano, APRN, Kathy Tsatsanis, PhD, Katarzyna Chawarska, PhD, Sophy Kim, PhD, Susan Dieterich, PhD, Karen Bearrs, PhD, Nancy Peters, RN, Patricia Brown, BSN, Emily Ansusinha, BA, Ellen Waldrep, PhD, Jackie Friedman, PhD, Gail Hounshell, PhD, Debbie Allred, PhD, Stephen C. Engelke, MD, Nancy Darden-Saad, BS, RN, CCRC, Gary Stainback, PhD, Diane Warner, MD, MPH, Janice Wereszczak, MSN, PNP, Janice Bernhardt, MS, RN, Joni McKeeman, PhD, Echo Meyer, PhD, Steve Pastyrnak, PHD, Julie Rathbun, BSW, BSN, RN, Sarah Nota, BS, Teri Crumb, BSN, RN, CCRC, Madeleine Lenski, MPH, Deborah Weiland, MSN, Megan Lloyd, MA, EdS, Scott Hunter, PhD, Michael Msall, MD, Rugile Ramoskaite, BA, Suzanne Wiggins, MA, Krissy Washington, MA, Ryan Martin, MA, Barbara Prendergast, BSN, RN, Megan Scott, PhD, Judith Klarr, MD, Beth Kring, RN, Jennifer DeRidder, RN, Kelly Vogt, PhD

1 Department of Pediatrics, Boston Medical Center, Boston, MA 
2 Department of Anatomy and Neuroanatomy, Boston University, Boston, MA 
3 Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of North Carolina, Chapel Hill, NC 
4 Department of Neurology, Harvard Medical School, Boston, MA 
5 Department of Neurology, Neuroepidemiology Unit, Boston Children's Hospital, Boston, MA 
6 Department of Biostatistics, Boston University School of Public Health, Boston, MA 
7 Division of Pediatric Neurology, Department of Neurology, Johns Hopkins Hospital, Baltimore, MD 
8 Department of Radiology, Boston Medical Center, Boston University, Boston, MA 
9 Department of Psychiatry, University of Massachusetts Medical School/University of Massachusetts Memorial Health Care, Worcester, MA 
10 National Institute of Neurological Disorders and Stroke, Bethesda, MD 

∗Reprint requests: Karl C. K. Kuban, MD, SMEpi, Department of Pediatrics, Boston Medical Center, 1 Boston Medical Center Place Dowling Building, 3-South, Room 3314, Boston, MA 03118.Department of PediatricsBoston Medical Center1 Boston Medical Center Place Dowling Building3-South, Room 3314BostonMA03118

Abstract

Objectives

To compare the prevalence of cognitive, neurologic, and behavioral outcomes at 10 years of age in 428 girls and 446 boys who were born extremely preterm.

Study design

A total of 889 of 966 eligible children previously enrolled in the multicenter Extremely Low Gestational Age Newborns Study from 2002-2004 were evaluated at 10 years of age. Children underwent a neuropsychological battery and testing for autism spectrum disorder (ASD), and parents reported on their child's behavior, development, and seizures.

Results

Of the children, 28% of boys and 21% of girls exhibited moderate to severe impairment on summary measures of cognitive abilities. Boys had a higher prevalence of impairment than girls in nearly all measures of cognition, were more than twice as likely to have microcephaly (15% in boys, 8% in girls), and require more often assistive devices to ambulate (6% in boys, 4% in girls). In contrast, boys and girls had comparable risk for a history of seizure (identified in 10% of the cohort) or epilepsy (identified in 7% of the cohort). The boy-to-girl ratio of ASD (9% in boys, 5% in girls) was lower than expected compared with the overall US autism population.

Conclusions

In this contemporary cohort of children born extremely premature and evaluated at school age, boys had higher prevalence of cognitive, neurologic, and behavioral deficits than girls. The ratio of boys to girls among those with ASD deserves further study as does the perinatal environmental-genetic interactions that might contribute to male preponderance of deficits in this high-risk sample.

Le texte complet de cet article est disponible en PDF.

Keywords : extremely low gestational age newborns, neurological follow-up, late childhood, cognition, executive function, autism, microcephaly, motor impairment

Abbreviations : ADI-R, ADOS-2, ASD, DAS-II, EF, ELGAN, EP, LPA, NEPSY-II


Plan


 Supported by the National Institute of Neurological Disorders and Stroke (5U01NS040069-05 and 2R01NS040069-09) and the National Institute of Child Health and Human Development (5P30HD018655-28). J.F. receives grant and research support from Alcobra, Forest Pharmaceuticals, Janssen Research and Development, Pfizer, Inc., Neuren, Roche, Seaside Therapeutics, and SyneuRX International, and sits on a Data Safety Board for an adolescent clinical trial supported by Forest Pharmaceuticals. The authors declare no conflicts of interest.


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Vol 173

P. 69 - juin 2016 Retour au numéro
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