Original Article
Developmental Delay in Moderately Preterm-Born Children at School Entry

https://doi.org/10.1016/j.jpeds.2010.12.041Get rights and content

Objective

To determine the prevalence and nature of developmental delay at preschool age in infants born moderately preterm compared with those born full-term and early preterm.

Study design

Parents of 927 moderate preterm infants (32-35+6 weeks gestation), 512 early preterm infants (<32 weeks gestation) and 544 full-term infants (38-41+6 weeks gestation) completed the Ages and Stages Questionnaire (ASQ) when the child was aged 43-49 months. We analyzed rates of abnormal ASQ scores and odds ratios for abnormal ASQ scores in both preterm groups compared with the full-term group. We repeated the analyses after adjustment for socioeconomic status, sex, being part of a multiple birth, and small for gestational age status.

Results

Abnormal (ie, >2 SDs below the mean) ASQ total scores were noted in 8.3% of moderate preterm infants, in 4.2% of full-term infants, and in 14.9% of early preterm infants. ORs of abnormal ASQ total scores were 2.1 (95% CI, 1.3-3.4) for moderate preterm infants and 4.0 (95% CI, 2.4-6.5) for early preterm infants. Both moderate and early preterm infants had more frequent problems with fine motor, communication, and personal-social functioning compared with full-term infants. Compared with full-term infants, moderate preterm infants did not have a greater prevalence of problems with gross motor functioning and problem solving, whereas early preterms did. Socioeconomic status, small for gestational age status, and sex were associated with abnormal ASQ scores in moderate preterm infants.

Conclusions

At preschool age, the prevalence of developmental delay in moderate preterm infants was 2-fold of that in full-term infants and one-half of that in early preterm infants.

Section snippets

Methods

Longitudinal Preterm Outcome Project (Lollypop) is a large prospective cohort study on the growth, development, and general health of preterm children.13 The study’s main focus is on moderate preterm infants, born between 32 and 35+6 weeks gestation. The Lollypop cohort comprises a community-based sample of early and moderate preterm (born before 36 weeks gestation) infants and a random sample of full-term infants seen at preventive child healthcare centers (PCHCs), enriched with a sample of

Results

A total of 2517 of the 3194 eligible children (78.8%) were recruited for the study. Parents of 2050 of these children (81.4%) completed the ASQ. In >95% of cases, the mother filled out the ASQ. The median age of the children at completion of the ASQ was 46 months. Of the 2050 questionnaires, 1983 (97%) were completed within 3 months of the median age at completion (43-49 months). The final analyses were performed on this group, referred to hereinafter as “participating children.” Table I

Discussion

This study demonstrates a 2-fold greater prevalence of developmental delay at preschool age in moderately preterm‒born children compared with term-born children, and half the prevalence compared with early preterm‒born children. At preschool age, moderate preterm infants were more likely than full-term infants to have problems with fine motor, communication, and personal-social functioning. In these 3 domains, moderate preterm infants had problems similar to those of early preterm infants, but

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  • Cited by (0)

    Supported by grants from the research foundation of the Beatrix Children’s Hospital, the Cornelia Foundation for the Handicapped Child, the A. Bulk-Child Preventive Child Health Care Research Fund, the Dutch Brain Foundation, and unrestricted investigator-initiated research grants from Friesland Campina, Hero, Abbott, and Pfizer Europe. The financers had no role at any stage of the project, including the decision to submit the manuscript. The authors declare no conflicts of interest.

    This study is part of a larger cohort study on the development, growth, and health of preterm-born children known as the Lollypop Study (controlled-trials.com ISRCTN 80622320). It is part of the study program of the postgraduate School of Behavioral and Cognitive Neurosciences, University of Groningen. The Ages-and-Stages Questionnaire 48-month form was translated with permission from the author.

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