The Neurobehavioral Phenotype of School-Aged, Very Prematurely Born Children with No Serious Neurological Sequelae: A Quality of Life Predictor

Abstract

School-aged extremely preterm (EPT) children have multiple specific neurocognitive/behavioral disorders that are often associated with other disorders; this manifests a true neurobehavioral "phenotype" of prematurity. To determine a profile of cognitive/behavioral impairments in a population of school-aged EPT children (7-10 years-old) without major disabilities, a cross-sectional study was conducted in five medical centers. An algorithm distributed the study population according to four WISC-IV subtests, five NEPSY-2 subtests, and two variables of figure of Rey. The behavior (SDQ), anxiety (Spielberg STAI-C), and generic QoL (Kidscreen 10 and VSP-A) were also evaluated. The study included 231 school-aged EPT children. Three neurobehavioral "phenotypes" were defined according to their severity: 1 = moderately, 2 = minor, and 3 = unimpaired. In all the profiles, the working memory, perceptual reasoning, as well as mental flexibility, were close to or below average, and their emotional behavior was always troubled. Self-esteem and school-work were the most impacted QoL areas. The unimpaired neurobehavior exhibited emotional behavioral impairment and executive dysfunction. The profile analysis defined distinct outcome groups and provided an informative means of identifying factors related to developmental outcomes. The QoL deterioration is determined by the severity of the three neurobehavioral "phenotypes", which is defined as well as by dysexecutive and/or behavioral disorders.

Keywords: anxiety; extremely pre-term children; neurocognitive/behavioral disorders; quality of life.

Figure 1

Study population’s flow chart. Note: Quality of Life (QoL); Cluster 1: Moderate Impaired NeuroBehavior (MODINB); Cluster 2: Minor Impaired NeuroBehavior (MINB); Cluster 3: UnImpaired NeuroBehavior (UINB).

Figure 2

Neuropsychological evaluation of the four WISC IV indices by cluster. Note: Verbal comprehension index (VCI), perceptual reasoning index (PRI), working memory (WMI), and processing speed index (PSI). Average = 100, 1 SD = 15.

Figure 3

Neuropsychological assessment: planning, mental flexibility, auditory, and visual attention according to the clusters. Note: Average: 10, deviation: 3. A <8 score reflected a disorder in the category concerned: <−1 SD).

Figure 4

Anxiety assessment by STAI questionnaire and behavior assessments by Goodman-SDQ test by clusters. Note: Goodman-SDQ (Strengths and Difficulties Questionnaire): Scores were correlated with Achenbach’s Child Behavior Checklist (CBCL), including 25 items targeted for the parents. The questionnaire reflected a total assessment score of the difficulties and defined five subcategories composed of five items each: emotional disorders: average: 0–3, slightly below average: 4, high: 5–6, very high 7–10; behaviors: average: 0–2, slightly below average: 3, high: 4–5, very high 6–10; hyperactivity: average: 0–5, slightly below average: 6–7, high: 4–5, very high 6–10; social relationship disorder: average: 0–2, slightly below average: 3, high: 4–6, very high 7–10. A total difficulty score was the sum of the first four items, with each one-point increase corresponding to an increase in the risk of developing a mental disorder. The categories assessed was in the average 0–13, slightly below the average 14–16, high 17–19, or very high 20–40. “Prosocial” behavior is counted separately and varies in the opposite direction: average: 8–10, slightly below average: 7, high: 6, very high 0–5. STAIC: State–Trait Anxiety Inventory for children. Schematically: standard anxiety state: Normal: 20–40, High Anxiety: higher than 40.