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. 2020 Apr:219:152-159.e5.
doi: 10.1016/j.jpeds.2019.12.028. Epub 2020 Jan 31.

Behavior Profiles at 2 Years for Children Born Extremely Preterm with Bronchopulmonary Dysplasia

Jane E Brumbaugh  1 , Edward F Bell  2 , Scott F Grey  3 , Sara B DeMauro  4 , Betty R Vohr  5 , Heidi M Harmon  2 , Carla M Bann  6 , Matthew A Rysavy  2 , J Wells Logan  7 , Tarah T Colaizy  2 , Myriam A Peralta-Carcelen  8 , Elisabeth C McGowan  5 , Andrea F Duncan  9 , Barbara J Stoll  9 , Abhik Das  3 , Susan R Hintz  10 ; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network
Collaborators, Affiliations

Behavior Profiles at 2 Years for Children Born Extremely Preterm with Bronchopulmonary Dysplasia

Jane E Brumbaugh et al. J Pediatr. 2020 Apr.

Abstract

Objective: To characterize behavior of 2-year-old children based on the severity of bronchopulmonary dysplasia (BPD).

Study design: We studied children born at 22-26 weeks of gestation and assessed at 22-26 months of corrected age with the Child Behavior Checklist (CBCL). BPD was classified by the level of respiratory support at 36 weeks of postmenstrual age. CBCL syndrome scales were the primary outcomes. The relationship between BPD grade and behavior was evaluated, adjusting for perinatal confounders. Mediation analysis was performed to evaluate whether cognitive, language, or motor skills mediated the effect of BPD grade on behavior.

Results: Of 2310 children, 1208 (52%) had no BPD, 806 (35%) had grade 1 BPD, 177 (8%) had grade 2 BPD, and 119 (5%) had grade 3 BPD. Withdrawn behavior (P < .001) and pervasive developmental problems (P < .001) increased with worsening BPD grade. Sleep problems (P = .008) and aggressive behavior (P = .023) decreased with worsening BPD grade. Children with grade 3 BPD scored 2 points worse for withdrawn behavior and pervasive developmental problems and 2 points better for externalizing problems, sleep problems, and aggressive behavior than children without BPD. Cognitive, language, and motor skills mediated the effect of BPD grade on the attention problems, emotionally reactive, somatic complaints, and withdrawn CBCL syndrome scales (P values < .05).

Conclusions: BPD grade was associated with increased risk of withdrawn behavior and pervasive developmental problems but with decreased risk of sleep problems and aggressive behavior. The relationship between BPD and behavior is complex. Cognitive, language, and motor skills mediate the effects of BPD grade on some problem behaviors.

Keywords: BPD; bayley scales of infant and toddler development; child behavior checklist; cognitive; infants born premature; language; motor.

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Figures

Figure 1.
Figure 1.
Mediation model.
Figure 2.
Figure 2.
Flow chart of children.
Figure 3.
Figure 3.
Adjusted mean differences in CBCL scores by bronchopulmonary dysplasia grade. Mean differences are adjusted for sex, gestational age, SGA, race, Hispanic ethnicity, maternal education, insurance type, center, grade III/IV ICH, severe ROP, and postnatal steroids.
Figure 4.
Figure 4.
Path diagram of Bayley cognitive, language, and motor scores as mediators of bronchopulmonary dysplasia grade’s effect on CBCL syndrome scales. *p <0.05. Values shown are standardized path coefficients. Path coefficients are adjusted for sex, gestational age, SGA, race, Hispanic ethnicity, maternal education, insurance type, center, grade III/IV ICH, severe ROP, and postnatal steroids.
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