Neurodevelopmental profiles of infants born <30 weeks gestation at 2 years of age

Abstract

Background: Infants born <30 weeks postmenstrual age (PMA) are at increased risk for neurodevelopmental impairment by age 2. Prior studies report rates of impairment for individual outcomes separately. Our objective was to describe neurodevelopmental profiles of children born <30 weeks PMA, using cognitive, language, motor, and behavioral characteristics.

Methods: We studied 587 children from a multi-center study of infants born <30 weeks PMA. Age 2 outcomes included Bayley-III subscale scores, Child Behavior Checklist syndrome scores, diagnosis of cerebral palsy (CP), and positive screen for autism spectrum disorder (ASD) risk. We used latent profile analysis (LPA) to group children into mutually exclusive profiles.

Results: We found four discrete neurodevelopmental profiles indicating distinct combinations of developmental and behavioral outcomes. Two of the profiles included 72.7% of the sample with most having Bayley scores within the normal range. The other two profiles included the remaining 27.3% of the sample with most having Bayley scores outside of the normal range. Only one profile (11% of sample) was comprised of children with elevated behavioral problems.

Conclusion: Child-centered analysis techniques could facilitate the development of targeted intervention strategies and provide caregivers and practitioners with an integrative understanding of child behavior.

Impact: Most studies examining neurodevelopmental outcomes in very preterm children report rates of impairment for individual outcomes separately. Comprehensive, "child-centered" approaches that integrate across multiple domains can be used to identify subgroups of children who experience different types of neurodevelopmental impairments. We identified four discrete neurodevelopmental profiles indicating distinct combinations of developmental and behavioral outcomes in very preterm children at 24 months. "Child-centered" analysis techniques may provide clinically useful information and could facilitate the development of targeted intervention strategies for high-risk children.

Figure 1.

Means of Bayley and CBCL scores (left y-axis) and risk for CP and ASD (right y-axis) by latent profile. Bayley outcomes are subscale scores (M = 10, SD = 3). CBCL outcomes are syndrome scale raw scores. Children in profile 1 (black; 31%) had optimal outcomes, profile 2 (blue; 41%) had typical outcomes, profile 3 (purple; 11%) had low Bayley scores and high CBCL scores, and profile 4 (red; 16%) had the lowest Bayley scores. Color shading provides information about normal limits (green), low or borderline elevated scores (yellow), and very low or clinically elevated (orange) scores. For CBCL, while raw scores were used to estimate models, interpretive background shading is based on corresponding t-scores. COG = Bayley cognitive; EC = Bayley expressive communication; RC = Bayley receptive communication; FM = Bayley fine motor; GM = Bayley gross motor; Emot = CBCL emotionally reactive; Anx/Dep = CBCL anxious/depressed; Somat = CBCL somatic complaints; Withdrawn = CBCL withdrawn; Sleep = CBCL sleep problems; Attention = CBCL attention problems; Aggressive = CBCL aggressive behaviors, WNL = within normal limits.