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J Pediatr. 2018 Oct 3. pii: S0022-3476(18)31233-2. doi: 10.1016/j.jpeds.2018.08.059. [Epub ahead of print]

Behavioral Deficits at 18-22 Months of Age Are Associated with Early Cerebellar Injury and Cognitive and Language Performance in Children Born Extremely Preterm.

Collaborators (251)

Jobe AH6, Caplan MS7, Laptook AR8, Vohr BR8, Oh W8, Hensman AM8, Alksninis B8, Andrews D8, Angela K8, Barnett S8, Cashore B8, Caskey M8, Francis K8, Gingras D8, Johnson K8, Leach TM8, Stephens BE8, Watson VE8, Walsh MC9, Fanaroff AA9, Newman NS9, Wilson-Costello DE9, Siner BS9, Zadell A9, DiFiore J9, Bhola M9, Friedman HG9, Yalcinkaya G9, Bulas D10, Goldberg RN11, Cotten CM11, Goldstein RF11, Ashley P11, Auten KJ11, Fisher KA11, Foy KA11, Freedman SF11, Gustafson KE11, Lohmeyer MB11, Malcolm WF11, Wallace DK11, Carlton DP12, Stoll BJ12, Adams-Chapman I12, Buchter S12, Piazza AJ12, Carter S12, Fritz S12, Hale EC12, Hutchinson AK12, LaRossa MM12, Higgins RD13, Archer SW13, Sokol GM14, Poindexter BB14, Dusick AM14, Lemons JA14, Wilson LD14, Hamer F14, Cook AB14, Herron DE14, Lytle C14, Minnich HM14, Berberich MA15, Blaisdell CJ15, Gail DB15, Kiley JP15, Das A16, Gantz MG16, Newman JE16, Cheng H16, Hastings BK16, McClure EM16, Auman JO16, Huitema CP16, Poole WK16, Pickett JW 2nd16, Wallace D16, Wrage LA16, Zaterka-Baxter KM16, Van Meurs KP17, Stevenson DK17, Ball MB17, Barnes PD17, Bentley B17, Bruno EF17, DeAnda ME17, DeBattista AM17, Kohn JG17, Proud MS17, Pyle RP17, Weiss HE17, Frantz ID 3rd18, Fiascone JM18, McGowan EC18, Furey A18, MacKinnon BL18, Nylen E18, Brussa A18, Sibley C18, Carlo WA19, Ambalavanan N19, Collins MV19, Cosby SS19, Phillips VA19, Bailey KJ19, Biasini FJ19, Hopkins M19, Johnston KC19, Nelson KG19, Patterson CS19, Rector RV19, Rodriguez L19, Soong A19, Whitley S19, York S19, Finer NN20, Rasmussen MR20, Wozniak PR20, Vaucher YE20, Rich W20, Arnell K20, Barbieri-Welge R20, Ben-Tall A20, Bridge R20, Demetrio C20, Fuller MG20, Ito E20, Lukasik M20, Pontillo D20, Posin D20, Runyan C20, Wilkes J20, Zlotnik P20, Bell EF21, Widness JA21, Acarregui MJ21, Klein JM21, Colaizy TT21, Johnson KJ21, Eastman DL21, Duara S22, Bauer CR22, Everett-Thomas R22, Calejo M22, Diaz AN22, Frade Eguaras SM22, Garcia A22, Hamlin-Smith K22, Berkowits MH22, Hiriart-Fajardo S22, Mathews EO22, Pierre H22, Riguard A22, Stroerger A22, Watterberg KL23, Ohls RK23, Fuller J23, Rohr J23, Lacy CB23, Lowe J23, Montman R23, Brown S23, Laroia N24, Phelps DL24, Myers GJ24, Markowitz GD24, Reubens LJ24, Hust D24, Augostino L24, Johnson JB24, Burnell E24, Gelbard H24, Jensen RL24, Kushner E24, Merzbach J24, Mink J24, Torres C24, Wang D24, Yost K24, Sánchez PJ25, Rosenfeld CR25, Salhab WA25, Heyne RJ25, Adams SS25, Allen J25, Grau L25, Guzman A25, Hensley G25, Heyne ET25, Hickman JF25, Leps MH25, Madden LA25, Martin M25, Miller NA25, Morgan JS25, Solis A25, Torres LE25, Boatman CT25, Vasil DM25, Kennedy KA26, Tyson JE26, Evans PW26, Akpa EG26, Alaniz NI26, Harris BF26, Green C26, Jiminez M26, Lis AE26, Martin S26, McDavid GE26, Morris BH26, Poundstone ML26, Reddoch S26, Siddiki S26, Pierce Tate PL26, Wright SL26, Yoder BA27, Faix RG27, Baker S27, Bird K27, Bullwinkle AE27, Burnett J27, Cole L27, Osborne KA27, Spencer C27, Steele RE27, Steffen M27, Weaver-Lewis K27, O'Shea TM28, Dillard RG28, Washburn LK28, Peters NJ28, Jackson BG28, Chiu K28, Allred DE28, Goldstein DJ28, Halfond R28, Peterson C28, Waldrep EL28, Welch CD28, Morris MW28, Hounshell GW28, Shankaran S29, Sood BG29, Slovis TL29, Pappas A29, Bara R29, Billian E29, Goldston LA29, Johnson M29.

Author information

1
Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of Texas Health Science Center at Houston, Houston, TX. Electronic address: andrea.f.duncan@uth.tmc.edu.
2
Statistics and Epidemiology Unit, RTI International, Research Triangle Park, NC.
3
Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of Texas Health Science Center at Houston, Houston, TX.
4
Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL.
5
Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Stanford University, Palo Alto, CA.
6
University of Cincinnati, Cincinnati, OH.
7
University of Chicago, Pritzker School of Medicine, Chicago, IL.
8
Alpert Medical School of Brown University and Women & Infants Hospital of Rhode Island, Providence, RI.
9
Case Western Reserve University, Rainbow Babies & Children's Hospital, Cleveland, OH.
10
Children's National Medical Center, Washington, DC.
11
Duke University School of Medicine, University Hospital, Alamance Regional Medical Center, Durham Regional Hospital, Durham, NC.
12
Emory University, Children's Healthcare of Atlanta, Grady Memorial Hospital, Emory Crawford Long Hospital, Atlanta, GA.
13
Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD.
14
Indiana University, University Hospital, Methodist Hospital, Riley Hospital for Children, Wishard Health Services, Indianapolis, IN.
15
National Heart, Lung, and Blood Institute, Bethesda, MD.
16
RTI International, Research Triangle Park, NC.
17
Stanford University and Lucile Packard Children's Hospital, Stanford, CA.
18
Tufts Medical Center, Floating Hospital for Children, Boston, MA.
19
University of Alabama at Birmingham Health System and Children's Hospital of Alabama, Birmingham, AL.
20
University of California - San Diego Medical Center and Sharp Mary Birch Hospital for Women, San Diego, CA.
21
University of Iowa Children's Hospital, Iowa City, IA.
22
University of Miami, Holtz Children's Hospital, Miami, FL.
23
University of New Mexico Health Sciences Center, Albuqurque, NM.
24
University of Rochester Medical Center, Golisano Children's Hospital, Rochester, NY.
25
University of Texas Southwestern Medical Center at Dallas, Parkland Health & Hospital System, Children's Medical Center Dallas, Dallas, TX.
26
University of Texas Health Science Center at Houston Medical School and Children's Memorial Hermann Hospital, Houston, TX.
27
University of Utah Medical Center, Intermountain Medical Center, LDS Hospital, Primary Children's Medical Center, Salt Lake City, UT.
28
Wake Forest University, Baptist Medical Center, Brenner Children's Hospital, Forsyth Medical Center, Winston-Salem, NC.
29
Wayne State University, Hutzel Women's Hospital, Children's Hospital of Michigan, Detroit, MI.

Abstract

OBJECTIVE:

To investigate associations in toddlers born extremely preterm (<28 weeks) between neonatal neuroimaging and 18- to 22-month developmental and behavioral outcomes.

STUDY DESIGN:

Cohort analysis from the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network Surfactant Positive Airway Pressure and Pulse Oximetry Trial Neuroimaging and Neurodevelopmental Outcomes Study of infants born extremely preterm. Subjects underwent cranial ultrasonography and near-term magnetic resonance imaging (MRI). At 18-22 months of corrected age, the assessment included the Brief Infant Toddler Social Emotional Assessment (BITSEA) Problem and Competence Scale scores and the Bayley Scales of Infant Development, Third Edition (Bayley-III). The BITSEA Problem Scale assesses dysregulation; the Competence Scale assesses social-emotional competence. We examined associations of Problem and Competence scores and positive screen rates with cranial ultrasonography and near-term MRI. Mean BITSEA and Bayley-III scores were compared using ANOVA and positive screen rates with the χ2 test. We computed correlations between BITSEA and Bayley-III scores.

RESULTS:

Of the 397 children, positive BITSEA screens were found in 34% for the Problem score and 26% for the Competence score. Presence of lesions on near-term MRI that included cerebellar lesions were significantly associated with lower BITSEA Competence but not with Problem scores; Competence scores were inversely related to the presence/significance of lesions. Positive screens on Competence scores and on both Competence and Problem scores were significantly associated with Bayley-III cognitive and language scores <85 (P < .001).

CONCLUSIONS:

Social-emotional competence contributes to deficits in cognitive and language development. Presence of injury on near-term MRI that includes cerebellar lesions is associated with later social-emotional competence and may be a useful predictor to guide early assessment and intervention.

TRIAL REGISTRATION:

ClinicalTrials.gov: NCT00063063 and NCT00233324.

KEYWORDS:

behavior; extremely preterm; neuroimaging

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