Presented at the Neonatal Society 2009 Autumn Meeting.
Johnson S1,4, Wolke D2, Hollis C3, Kochhar P3, Marlow N1
1 Academic Neonatology, Institute for Women’s Health, University College London, London, UK
2 Warwick Medical School, University of Warwick, Coventry, UK
3 School of Community Health Sciences, University of Nottingham, Nottingham, UK
4 School of Clinical Sciences, University of Nottingham, Nottingham, UK
Background: Studies using screening tools have consistently reported a significant excess of behavioural and emotional problems in preterm survivors, yet there is a paucity of information regarding psychiatric disorders.
Aim: We have investigated the prevalence of psychiatric and behavioural disorders in extremely preterm children at school age.
Methods: All babies born <26 weeks gestation and admitted for intensive care in the UK and Ireland, March-December, 1995 were recruited to the EPICure Study. Of 307 survivors at 11 years of age, 219 (71%) were assessed and compared with 153 term-born classmates. Parents and teachers completed the Development and Well Being Assessment (DAWBA), a psychiatric evaluation used to diagnose childhood psychiatric and behavioural disorders. DSM-IV-TR diagnoses were assigned by two clinicians blind to group allocation for 219 (100%) extremely preterm children and 152 (99%) classmates.
Results: Extremely preterm children were at significantly higher risk for psychiatric disorders than classmates (23% vs. 9%; OR 3.2; 95%CI 1.7 to 6.2). Risk was significantly increased in extremely preterm children for ADHD (11.5% vs. 2.9%; 4.3; 1.5 to 13.0), emotional disorders (9.0% vs. 2.1%; 4.6; 1.3 to 15.9) and Autism Spectrum Disorders (8.0% vs. 0%; p=0.000). There was no excess of conduct disorders in extremely preterm children (5.9% vs. 5.5%; 0.9; 0.4 to 2.2).
Conclusion: Extremely preterm children are at high risk for ADHD, emotional disorders and autism spectrum disorders in middle childhood. Routine behavioural screening to facilitate early psychiatric referral may be beneficial in reducing psychiatric morbidity in extremely preterm children.
References
1. Hack, M., Taylor, H. G., Schlichter, M., Andreias, L., Drotar, D., & Klein, N. (2009). Behavioral outcomes of extremely low birth weight children at age 8 years. Journal of Developmental and Behavioral Pediatrics, 30(2), 122-130.
2. Goodman, R., Ford, T., Richards, H., Gatward, R., & Meltzer, H. (2000). The Development and Well-Being Assessment: Description and initial validation of an integrated assessment of child and adolescent psychopathology. Journal of Child Psychology, Psychiatry and Allied Disciplines, 41(5), 645-655.