Social-emotional delays at 2 years in extremely low gestational age survivors: correlates of impaired orientation/engagement and emotional regulation

Early Hum Dev. 2013 Dec;89(12):925-30. doi: 10.1016/j.earlhumdev.2013.09.019. Epub 2013 Oct 18.

Abstract

Background: Premature infants are less socially and emotionally competent at school age than infants born at term.

Aims: To evaluate the correlates of social and emotional delays at 2 years of age among prematurely born children.

Study design: This is a prospective cohort study.

Subjects: 904 children born at <28 weeks gestation during 2002-2004 and enrolled in the ELGAN study who survived until age 2 years and returned for a developmental assessment.

Outcome measures: The Bayley Behavior Rating Scale (BRS), a neurological examination, and the Bayley Scales of Infant Development II (BSID-II).

Results: Fully 31% of children had a non-optimal (14%) or questionable (17%) (NO/Q) BRS score for Emotional Regulation (ER), and 27% had a non-optimal (13%) or questionable (14%) score for Orientation/Engagement (O/E). Children with NO/Q scores on ER and O/E were more likely than others to have MDI and PDI scores <70 and be unable to walk. Antecedents of NO/Q OE scores included multi-fetal pregnancy, while antecedents of NO/Q scores for both ER and O/E included indicators of socioeconomic disadvantage, and male sex.

Conclusions: Over 25% of children born extremely premature exhibit socio-emotional delays during developmental assessment at age 2 years. Antecedents of these delays include sociodemographic characteristics, as well as those common antecedents of other impairments commonly observed among extremely preterm infants.

Keywords: BRS; BSID-II; Bayley Scales Infant Development-II; Behavior Rating Scale; Behavioral regulation; Brain injury; ELGAN; ER; Emotional Regulation; Extreme prematurity; Extremely Low Gestational Age Newborn; GMFCS; Gross Motor Function Classification System; IVH; MDI; Mental Development Index; NO/Q; Neurodevelopmental disability; O/E; Orientation Engagement; PDI; Psychomotor Development Index; intraventricular hemorrhage; non-optimal or questionable.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Child Development / physiology*
  • Child, Preschool
  • Developmental Disabilities / epidemiology*
  • Developmental Disabilities / pathology
  • Emotional Intelligence / physiology*
  • Gestational Age
  • Humans
  • Infant Behavior / physiology*
  • Infant, Extremely Premature / growth & development*
  • Infant, Newborn
  • Male
  • Neurologic Examination