Kristie McNealy, MD

A new study published in the September issue of Pediatrics found an increased frequency of behavioral problems in extremely premature children born at or before 25 weeks gestation.  The study was conducted at multiple centers in the UK and Ireland, and looked at behavioral reports from parents and teachers.  In total, reports on 200 preemies born at 25 weeks or less, with an average current age of about 6 years, were compared to 148 control children.

Researchers found that 19.4% of the preterm children had pervasive behavior problems, as compared to 3.4% of the control children.  Extremely preterm boys were most commonly affected (23.2%), and the difference between preterm boys and girls was greater than the gender difference seen among the controls.  Attention problems (33.4%) and hyperactivity (30.6%) were the most common behavioral problems among the extremely preterm children.  Problems like poor attention and poor peer relationships could not be explained by problems with cognitive function in the preemie group.

One of the major strengths of this study, is that it used both parent and teacher reports on each child included in the final analysis.  Many previous studies have included only parental reports.  Researchers suggest that the actual rate of pervasive behavioral problems among micro preemies could be even higher, because a number of the children in the study were lost to follow-up, or didn’t have adequately completed behavioral questionnaires.  Unfortunately, more profoundly impacted children are often end up being left out of the final analysis because their parents are too busy with their ongoing care to respond to study questionnaires, or they are unable to attend school.

Of course, more studies are needed, and we don’t have any concrete explanation as to why these pervasive behavioral issues seem to be confined to babies born at this gestational age.  While there are many theories, it seems logical that birth at or before 25 weeks disrupts some critical part of brain development related to behavior.  Hopefully future research will give us a better understanding of exactly what is going on so future preemie parents can have a clearer picture of what to expect as their children grow.

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