Table 1.

Summary of Studies Reporting Risk Factor Analyses for General Behavioral Problems in Children Born Very Preterm or with Very Low Birth Weight

Study Reference	Country and Recruitment Period	Age of Assessment (yrs)	GA (wks)/Birth Weight (g)	Design and Participants	Number (%) of Survivors Assesseda	Outcome Measure (Continuous [cts] Unless Otherwise Specified)	Exclusion Criteria and/or Adjustment for Concurrent Neurodevelopmental Delay	Significant Risk Factors for Poorer Outcome (p < .05) in Final Model
Early childhood <5 yr
Stoelhorst et al29,b	The Netherlands, 1996–1997	2	<32 wks	PC of all live births in 3 Dutch health regions comprising 9% of the population	160 (68%)	Total problem score, internalizing and externalizing scale from the CBCL; parent report	Adjusted for: neurological abnormalities at 2 yr	Total problem: SGA Internalizing: SGA Externalizing: none significant
Spittle et al30	Australia, 2001–2003	2	<30 wks or <1250 g	PC study of infants admitted to a single center NICU and enrolled in Victorian Infant Brain Studies (Melbourne)	188 (84%)	Externalizing, internalizing, dysregulation, and competence domains from ITSEA; parent report	None	Internalizing: higher social riskc Externalizing: none significant Dysregulation: none significant Competence: lower BW, PN steroids, female sex, moderate-severe WMA
Peralta-Carcelen et al31	United States, 1999–2001	2.5	<1000 g	Infants admitted to the NICU of 15 centers participating in the multicenter NICHD NRN routine FUP and enrolled in a glutamine supplementation RCT	696 (60%)	Total competence (≤15th vs >15th centile) and total problem score (≥75th vs <75th centile) from BITSEA; parent report	Excluded: blind, deaf, syndrome (n = 30) Adjusted for: CP, abnormal neurological examination, MDI <70, and PDI <70 from BSID-II at 2.5 yr	Total competence: Hispanic or non-white ethnicity, MDI <70 and PDI <70 from BSID-II at 2.5 yr Total problem: female sex, lower household income, MDI <70, and PDI <70 from BSID-II at 2.5 yr
Delobel-Ayoub et al32	France, 1997	3	<33 wks	PC of all live births in 9 French regions comprising one-third of all births (EPIPAGE Study); excluded multiples	1228 (69%)	Total difficulties score from SDQ (≤10th vs >10th centile of control group); parent report	Excluded: blind, deaf, severe CP (n = 63) Adjusted for: neurodevelopmental delay and health status at 3 yr	Hospitalization in last year, lower maternal age, lower maternal education, neurodevelopmental delay, and poor health status at 3 yr
Jones et al33	New Zealand, 1998–2000	4	<33 wks	PC of infants admitted to a single center NICU (Christchurch)	105 (98%)	Social competence composite score;d parent report	Excluded from all: blind (n = 1) Model 1: risk factors to term Model 2: adjusted for family functioning and parenting 2–4 yr Model 3: adjusted for factors in model 2 plus IQ at 4 yr	Model 1: family SES, male sex, severity of neonatal WMA Model 2: male sex, higher maternal anxiety at 2–4 yr, negative and intrusive parenting at 4 yr Model 3: GA <28 wks, higher maternal anxiety at 2–4 yr, negative and intrusive parenting at 4 yr, lower IQ at 4 yr
Middle childhood ≥5 yr
Delobel-Ayoub et al34	France, 1997	5	<33 wks	PC of all live births in 9 French regions comprising one-third of all births (EPIPAGE Study); excluded multiples	1102 (59%)	Total difficulties score from SDQ (≤10th vs >10th centile of control group); parent report	Excluded: blind, deaf, severe CP (n = 63) Adjusted for: IQ and development (parent reported) at 5 yr	Hospitalizations in last 5 yr, lower maternal age, poor maternal mental well-being in previous month, lower IQ, and delayed development at 5 yr
Stahlmann et al35	Germany, 1997–1999	7–9	<27 wks	PC of all live births in all 8 perinatal centers in Schleswig-Holstein	75 (82%)	Total difficulties score from SDQ; parent report	Adjusted for: IQ at 7–9 yr	Lower maternal education, IQ <70 at 7–9 yr
Taylor et al36,e	United States, 1992–1995	8	<1000 g	PC of infants admitted to a single center NICU (Ohio) participating in the multicenter NICHD NRN routine FUP	204 (86%)	Adaptive behavior composite score from the VABSS (cts and <1SD below mean of control group); parent report	Each risk factor was fitted separately and adjusted sex, race, parental SES, family stressors, and family resources (p values not reported)	Model 1 (cts score): longer neonatal hospital stay, outborn Model 2 (<70 vs ≥70): longer neonatal hospital stay, NRI >3

^aPercentage of survivors assessed for outcome measure specified.

^bNine models reported in total; total problem score, internalizing and externalizing scales and the 6 syndrome scores that comprise the total score.

^cSocial risk was based on a composite measure of 6 social risk factors: family structure, education of primary caregiver, occupation and employment status of primary income earner, language spoken at home, and maternal age at birth.

^dSocial competence composite score was derived by the authors by summing subscale scores across the following measures: SDQ, Behavioral Inventory of Executive Function—Preschool version (BRIEF-P), Emotional Regulation Checklist (ERC), Infant-Toddler Symptom Checklist (ITSC), Emotional Regulation subscale from BSID-II, and Penn Interactive Peer Play Scale (PIPPS). Three models were reported; the full model adjusting for IQ is reported in this review.

^eTwo models for Adaptive behavior composite and its 3 domains reported; one based on dichotomous outcome and one based on continuous outcome. BITSEA, Brief Infant-Toddler Social and Emotional Screening⁴³; BSID, Bayley Scales of Infant Development⁴⁴; BW, birth weight; CBCL, Child Behavior Checklist⁴⁵; CP, cerebral palsy; EPIPAGE, Etude Epidemiologique sur les Petits Ages Gestationnels; FUP, follow-up; GA, gestational age; IQ, intelligence quotient; ITSEA, Infant-Toddler Social and Emotional Assessment⁴⁶; MDI, Mental Developmental Index from the BSID-II; NICU, neonatal intensive care unit; NICHD NRN, National Institutes of Child Health and Human Development Neonatal Research Network; NRI, neonatal risk index; PC, prospective cohort; PDI, Psychomotor Developmental Index from the BSID-II; PN, postnatal; RCT, randomized controlled trial; SES, socioeconomic status; SDQ, Strengths and Difficulties Questionnaire⁴⁷; SGA, small for gestational age; VABSS, Vineland Adaptive Behavior Scales Screener⁴⁸; and WMA, white matter abnormality.