Antenatal and Early Postnatal Antecedents of Parent-Reported Attention Problems at 2 Years of Age - 18/09/14

Doi : 10.1016/j.jpeds.2014.08.004

L. Corbin Downey, MD, MPH ¹, T. Michael O'Shea, MD, MPH ¹, Elizabeth N. Allred, MS ², Karl Kuban, MD, MS ³, Thomas F. McElrath, MD, PhD ⁴, Diane D. Warner, MD, MPH ⁵, Janice Ware, PhD ⁶, Jonathan L. Hecht, MD, PhD ⁷, Andrew Onderdonk, PhD ⁸, Alan Leviton, MD, MS ²
on behalf of the
Extremely Low Gestational Age Newborn (ELGAN) Study^{^∗}
List of members of ELGAN Study is available at www.jpeds.com (Appendix).
¹ Division of Neonatology, Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC
² Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA
³ Division of Pediatric Neurology, Department of Pediatrics, Boston University, Boston, MA
⁴ Division of Maternal-Fetal Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA
⁵ Division of Neonatology, Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
⁶ Division of Developmental Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA
⁷ Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
⁸ Department of Pathology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Thursday 18 September 2014

Abstract

Objectives

To assess antenatal and early postnatal antecedents of attention problems identified by the Child Behavior Checklist in extremely preterm children.

Study design

In a cohort of 826 children born between 23 and 27 weeks' gestation, we collected demographic, birth, and postnatal information. We then identified behavior problems by using parent ratings from the Child Behavior Checklist at 2 years' adjusted age. We created time-oriented logistic regression risk models to identify significant risk factors for attention problems and Diagnostic and Statistical Manual of Mental Disorders–compatible attention deficit/hyperactivity problems (ADHP^DSM).

Results

Children were at increased risk of both attention problems if they were born to a woman who had no formal education beyond high school and/or a woman who was exposed to secondhand smoke. Recovery of a single organism from the placenta was associated with increased risk of an attention problem, and fetal stem vessel thrombosis and recovery of Mycoplasma species were associated with increased risk of ADHP^DSM. Infants of multifetal gestations were at reduced risk of both attention problems. The only postnatal risk factor for an attention problem was recovery of bacteria from a tracheal aspirate.

Conclusion

Among extremely preterm infants, several potentially modifiable antenatal and perinatal antecedents are associated with increased risk for attention problems and ADHP^DSM at 2 years adjusted age.

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Keyword : ADHD, ADHP^DSM, CBCL, DSM, ELGAN

Plan

Methods

Results

Discussion

Supported by the National Institute of Neurological Disorders and Stroke (5U01NS040069-05 and 2R01NS040069-06A2) and the National Institute of Child Health and Human Development (5P30HD018655-28). The authors declare no conflicts of interest.