An overview of mortality and sequelae of preterm birth from infancy to adulthood.

ContextPreterm infants have a high prevalence of long-term cognitive and behavioral
disturbances. However, it is not known whether the stresses associated with
premature birth disrupt regionally specific brain maturation or whether abnormalities
in brain structure contribute to cognitive deficits.ObjectiveTo determine whether regional brain volumes differ between term and
preterm children and to examine the association of regional brain volumes
in prematurely born children with long-term cognitive outcomes.Design and SettingCase-control study conducted in 1998 and 1999 at 2 US university medical
schools.ParticipantsA consecutive sample of 25 eight-year-old preterm children recruited
from a longitudinal follow-up study of preterm infants and 39 term control
children who were recruited from the community and who were comparable with
the preterm children in age, sex, maternal education, and minority status.Main Outcome MeasuresVolumes of cortical subdivisions, ventricular system, cerebellum, basal
ganglia, corpus callosum, amygdala, and hippocampus, derived from structural
magnetic resonance imaging scans and compared between preterm and term children;
correlations of regional brain volumes with cognitive measures (at age 8 years)
and perinatal variables among preterm children.ResultsRegional cortical volumes were significantly smaller in the preterm
children, most prominently in sensorimotor regions (difference: left, 14.6%;
right, 14.3% [P<.001 for both]) but also in premotor
(left, 11.2%; right, 12.6% [P<.001 for both]),
midtemporal (left, 7.4% [P = .01]; right, 10.2% [P<.001]), parieto-occipital (left, 7.9% [P = .01]; right, 7.4% [P = .005]), and subgenual
(left, 8.9% [P = .03]; right, 11.7% [P = .01]) cortices. Preterm children's brain volumes were significantly
larger (by 105.7%-271.6%) in the occipital and temporal horns of the ventricles
(P<.001 for all) and smaller in the cerebellum (6.7%; P = .02), basal ganglia (11.4%-13.8%; P≤.005),
amygdala (left, 20.2% [P = .001]; right, 30.0% [P<.001]), hippocampus (left, 16.0% [P = .001]; right, 12.0% [P = .007]), and corpus
callosum (13.1%-35.2%; P≤.01 for all). Volumes
of sensorimotor and midtemporal cortices were associated positively with full-scale,
verbal, and performance IQ scores (P<.01 for all).ConclusionsOur data indicate that preterm birth is associated with regionally specific,
long-term reductions in brain volume and that morphological abnormalities
are, in turn, associated with poorer cognitive outcome.

https://jamanetwork.com/journals/jama/articlepdf/193183/JOC00361.pdf

Regional brain volume abnormalities and long-term cognitive outcome in preterm infants.

Long-term follow-up of infants born prematurely is necessary to determine neurodevelopmental outcomes, particularly with the expansion of interest from major disabilities to high prevalence/low severity dysfunctions. Models of pathogenesis include changes due to developmental disruptions and to injury, the magnitude and type of change influenced by the infant's age, and central nervous system recovery and reorganization. Alterations in neurogenesis, migration, myelination, cell death, and synaptogenesis occur even in the absence of insult. Despite increased knowledge regarding these processes, the functional significance of brain abnormalities is unclear. Because of methodologic problems in follow-up studies, it is difficult to characterize outcome definitively. Nonetheless, an acceptable degree of agreement across studies is found with regard to specific neurodevelopmental outcomes: motor/neurologic function, visuomotor integrative skills, IQ, academic achievement, language, executive function, and attention-deficit hyperactivity disorder/behavioral issues. In general, children born prematurely have more problems in these areas than do their normal birth weight counterparts. Suggestions for improved analyses and clarification of outcomes include use of cluster analysis, structural equation modeling, growth curve analysis, developmental epidemiologic approaches, and better control of background variables using risk indexes and factor scores. Better assessment techniques measuring functions documented to be at higher risk of problems are discussed.

Neurodevelopmental outcomes of infants born prematurely.

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(15)01345-8.pdf

Comorbidity of fetal alcohol spectrum disorder: a systematic review and meta-analysis

Joseph Rowntree Foundation

The school-based behavioural adjustment at 7-8 years of a cohort of 243 prematurely born, very low birthweight (< 1501 g) children and their normal birthweight controls is reported The findings indicate that the children born preterm (both male and female) were rated by their teachers as expressing more behaviour problems than their controls, and were less well adjusted to the school environment The deficits noted in the preterms applied across the social classes, with no amelioration noted in preterms of higher social class It is speculated that the problem behaviours reflect a failure in self-regulatory functions

Behavioural adjustment in school of very low birthweight children.

Results of heavy drinking in pregnancy

Growth and development two years after artificial surfactant replacement at birth

Long term predictive value of Doppler studies in high risk fetuses.

Controlled trial of new formulae for feeding low birth weight infants.

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