Comorbidities Associated With Prematurity Essay

Describe the effect of extremely low birth weight babies on the family and community. Consider short-term and long-term impacts, socioeconomic implications, the need for ongoing care, and comorbidities associated with prematurity. Explain how disparities relative to ethnic and cultural groups may contribute to low birth weight babies. Identify one support service within your community to assist with preterm infants and their families and explain how the service adequately addresses the needs of the community, or a population in your community. Provide the link to the resource in your post.Comorbidities Associated With Prematurity Essay

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Perinatal factors have long been implicated in the genesis of psychiatric disorders, most notably in schizophrenia, but the role such factors play in the causal pathway is less well understood. For a long time, a range of biological insults, including preterm birth and LBW, were considered nonspecific triggers for later disorders (1). More recently, epidemiologic studies in the general population have identified significant inverse incremental associations with birthweight and/or GA at birth: the risk and prevalence of psychiatric morbidity increase as birthweight and GA decrease (2). Although these associations are not confined to those with very LBW (VLBW; birthweight ≤1500 g) or very preterm birth (VPT; <32 wk gestation), the risk is greatest for these groups (2,3). Preterm birth and LBW have also been identified as risk factors for specific psychiatric disorders, namely emotional disorders (2–5), attention deficit/hyperactivity disorders (ADHD) (6), and autism spectrum disorders (ASD) (7–10).Comorbidities Associated With Prematurity Essay

The casual pathway to these disorders must be interpreted in the context of the known neurologic sequelae of preterm birth, namely focal brain injury and altered brain development (11). These are manifest in the relationship between immaturity and CP (12) and low intelligent quotient (IQ) (13,14)/learning difficulties (15), respectively. The prevalence of impaired outcomes rises more steeply as GA falls below 32 wk and thus one might predict that psychiatric morbidity would be most prevalent in such populations. Where birthweight has been used to define populations, there may be differences in outcomes stemming from the excess of children born after fetal growth restriction, which have independent effects on psychiatric morbidity (16).

Several studies have now followed the progress of very immature cohorts born in the 1980s and 1990s through to adolescence and adult life, and have sought to define the full spectrum of impairment, including psychiatric disorders. We place emphasis on population-based studies, particularly for cohorts born in the 1990s, because these reflect the most contemporaneous outcomes relevant to current public health concerns. In this article, we review clinical studies of outcomes in middle childhood and beyond and present an overview of behavioral and psychiatric morbidity in relation to neurodevelopmental correlates and early predictors of disorders in preterm populations.Comorbidities Associated With Prematurity Essay

Prevalence and Profile of Behavior Problems
The majority of studies investigating morbidity for preterm (<37 wk)/LBW (<2500 g) cohorts have used behavioral screening questionnaires, such as the widely used Child Behavior Checklist (CBCL) (17). These provide cost- and time-efficient measures for large-scale use. Studies using screening questionnaires have shown that there is a significant excess of behavior problems in most preterm/LBW cohorts (18), and prevalence estimates range from 19 to 40% for LBW (19–22), 13 to 46% for VPT/VLBW (16,23–26), and 19 to 32% for extremely preterm (EPT: <26 wk)/extremely LBW (ELBW: ≤1000 g) (27–30) children. There is less consensus for children born moderate to late preterm (32–36 wk of gestation); some report an excess of behavior problems (31,32), whereas others report no significant difference from term peers (33). A GA-related gradient in outcomes is supported by a number of studies in which the prevalence of behavior problems was greater in those born at lower gestations or with LBW (26,34).Comorbidities Associated With Prematurity Essay

Variable findings are reported regarding the risk for internalizing and externalizing problems. In a meta-analysis of 16 case-control studies of school-aged VPT/VLBW children published in 1980–2001, 9 of 13 studies reported an increase in internalizing symptoms and 9 of 12 in externalizing symptoms (18). In a later meta-analysis of nine case-control studies of VPT (here defined as birth <34 wk)/VLBW children published between 1998 and 2008, parents rated their children as having more internalizing problems but combined effect sizes for parent- and teacher-rated externalizing problems were nonsignificant (35). More recent studies continue to report conflicting results regarding the risk for internalizing (28,31,34) and externalizing problems (23). Given the inverse relationship with maturity, some of this difference may be due simply to heterogeneity in population definitions.Comorbidities Associated With Prematurity Essay

There is greater consensus at the narrowband level in terms of behavioral profiles identified. Hille et al. (36) report cross-cultural outcomes in four population-based ELBW cohorts born in 1977–1987 and assessed using the CBCL. Externalizing scores were not elevated in any cohort and internalizing scores were increased only in one. In contrast, all four cohorts had significantly increased scores for social, thought, and attention scales (elevated by 0.5–1.2 SD relative to country-specific controls) and there was a marked absence of aggressive/delinquent behavior. In one cohort, scores for somatic complaints and anxiety/depression were also elevated. Similarly, in a more contemporary population of Swedish EPT children born 1990–1992, social, thought, and attention scales were 0.75–1.3 SD higher than controls (28). Studies using other popular screening tools, such as the Strengths and Difficulties Questionnaire (37), typically reveal a similar profile of increased risk for attention/hyperactivity, social, and emotional problems in preterm/LBW populations (19,24,29,38,39).Comorbidities Associated With Prematurity Essay

It is notable that the majority of studies report higher group mean scores on both broadband and narrowband scales, even where the proportion of children scoring in the abnormal range is not significantly increased. This implies that many children may have symptoms that fail to reach clinical significance. This is a consistent finding in studies using dimensional measures of symptomatology in VPT/VLBW populations, particularly for ADHD and ASD.Comorbidities Associated With Prematurity Essay

Although differences in screening tools, population definitions and age at assessment make direct comparisons of prevalence rates difficult, consistencies confirm a “preterm behavioral phenotype” characterized by inattention/hyperactivity, social, and emotional difficulties and, in general, a greater risk for internalizing rather than externalizing problems, which are more frequent at lower GAs. In the next section, we provide evidence to show that these findings are mirrored in diagnostic studies of psychiatric morbidity in preterm populations, which are characterized by significantly increased rates of ADHD, ASD, and emotional disorders.Comorbidities Associated With Prematurity Essay

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Prevalence and Prediction of Psychiatric Disorders
Studies using diagnostic evaluations are required to provide definitive evidence of an increased prevalence of disorders in preterm/LBW populations. There is a relative paucity of such studies as psychiatric evaluations are costly and difficult to implement in large-scale investigations. Although the majority of those that exist have used questionnaires that yield symptom data corresponding with Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnostic criteria (40), a small number have used more rigorous evaluations. Despite very different methodologies, these report similar prevalence estimates across a range of different populations (Table 1).Comorbidities Associated With Prematurity Essay

Table 1 Studies reporting the prevalence of psychiatric disorders using DSM diagnostic criteria in preterm and LBW children
Full size table
In two early studies using DSM-based questionnaires, Szatmari et al. (41,42) reported 24 to 27% prevalence of disorders in ELBW children. These rates were not significantly increased compared with controls, and in both studies, the risk of disorders was specific to ADHD. In the first study of psychopathology in ELBW children born in the 1990s, Hack et al. (43) reported a significant excess of psychiatric morbidity compared with controls with 32% prevalence of disorders in ELBW children. In all three studies, the prevalence of disorders in the control group (15–16%) was higher than the 10% typically observed in the general population (44) and may thus reflect that the measures were essentially screening tools.Comorbidities Associated With Prematurity Essay

In order to discuss the effects of premature birth in language acquisition and auditory maturation, it is important to bear in mind that full-term birth is defined as occurring within 37 and 42 weeks of gestational age, whereas preterm birth is considered before 37 weeks(1). It is also worth noting that the gestational age at birth establishes if prematurity is moderate (32 to 36 weeks of gestational age), severe (28 to 31 weeks) or extreme (less than 28 weeks). This factor, as well as weight at birth (low weight <2,500 grams; very low weight <1,500 grams and moderate low weight between 1,500 and 2,499 grams)(2), determines the basic biological conditions. These, in addition to perinatal and environmental conditions, can shape the development of infants.Comorbidities Associated With Prematurity Essay

It is known that, as medicine advances, survival of infants born with low weight (500-600 grams) increases, as does the responsibility of healthcare professionals in monitoring the clinical evolution of these infants(2,3). This increase in survival rates of ever smaller and premature infants compels questioning as to the quality of their future life as well as a growing interest in predicting their long-term global development(4,5). It is worth noting that in order to carry out these analyses in premature infants it is recommended that, for the first two years of life, the corrected age – also known as adjusted age – be considered as well(6). Corrected age translates the adjustment of chronological age according to the degree of prematurity, and is assessed by means of the Capurro or New Ballard method(7).Comorbidities Associated With Prematurity Essay

Due to this interest, several authors have identified abnormal neurological signs during these infants’ first year of age, although the studies encounter difficulties in predicting if these signs are definitive or temporary(4-8). It is observed that premature infants are at greater risk of development deficits than full-term infants, as the chances of premature infants presenting disabilities in cognitive and attention development and self-regulation are higher. These issues tend to continue throughout childhood, having been associated with learning and attention disabilities and behavioral problems(3-8).Comorbidities Associated With Prematurity Essay

Thus, we highlight the importance of studying the development of preterm infants within a context guided by association with different risk factors, which involve variables such as the birth and the outcomes of the infant’s clinical conditions during hospitalization(1).Comorbidities Associated With Prematurity Essay

It is known that certain neonatal complications may cause hearing impairment and are characterized as risk indicators for this condition – namely stay in neonatal ICU for 48 hours or more, weight at birth lower than 1,500 gr and/or small for gestational age (SGA); this category also includes infants large for gestational age (LGA) and appropriate for gestational age (AGA); hyperbilirubinemia/ exsanguinotransfusion; ototoxics and prolongued mechanical ventilation(9). Due to these factors, it is key to monitor these infants judiciously so as to monitor the development of their hearing and identify any types of hearing loss in time to harness the ideal period for language acquisition (first three years of life) and prevent effects of hearing on language development, as suggested by studies that found receptive and expressive linguistic deficits in these infants(10). Among deficits observed are smaller vocabulary, delay in language acquisition, less complex language, difficulties in phonological processing and short-term memory(11).Comorbidities Associated With Prematurity Essay

Therefore, understanding that prematurity is a biological risk factor for infants’ global development, which may be particularly harmful to the auditory pathway and language, this paper aims to verify which harms prematurity causes to language and hearing. Comorbidities Associated With Prematurity Essay