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The incidence and risk factors for psychiatric disorders in extremely preterm children are examined by observing babies born less than 26 weeks gestation in the UK and Ireland from March through December 1995. Extremely preterm children are shown to have higher risk for condition such as attention deficit hyperactivity disorder and autism spectrum disorders at 11 years of age.

Parent assessment of infants who were born very preterm reveal that these children at two years of age demonstrate significantly higher internalizing and dysregulation scores than peers born at term.

OBJECTIVE. To assess whether improvements in cognitive and behavioral development seen in preschool educational programs persist, we compared those in a multisite randomized trial of such a program over the first 3 years of life (INT) to those with follow-up only (FUO) at 18 months of age. METHODS. This was a prospective follow-up of the Infant Health and Development Program at 8 sites heterogeneous for sociodemographic characteristics. Originally 985 children were randomized to the INT (n = 377) or FUO (n = 608) groups within 2 birth weight strata: heavier low birth weight (HLBW; 2001-2499 g) and lighter low birth weight (LLBW; [less than or equal to] 2000 g). Primary outcome measures were the Peabody Picture Vocabulary Test (PPVT-III), reading and mathematics subscales of the Woodcock-Johnson Tests of Achievement, youth self-report on the Total Behavior Problem Index, and high-risk behaviors on the Youth Risk Behavior Surveillance System (YRBSS). Secondary outcomes included Weschler full-scale IQ, caregiver report on the Total Behavior Problem Index, and caregiver and youth self-reported physical health using the Medical Outcome Study measure. Assessors were masked as to study status. RESULTS. We assessed 636 youths at 18 years (64.6% of the 985, 72% of whom had not died or refused at prior assessments). After adjusting for cohort attrition, differences favoring the INT group were seen on the Woodcock-Johnson Tests of Achievement in math (5.1 points), YRBSS (-0.7 points), and the PPVT-III (3.8 points) in the HLBW youth. In the LLBW youth, the Woodcock-Johnson Tests of Achievement in reading was higher in the FUO than INT group (4.2). CONCLUSIONS. The findings in the HLBW INT group provide support for preschool education to make long-term changes in a diverse group of children who are at developmental risk. The lack of observable benefit in the LLBW group raises questions about the biological and educational factors that foster or inhibit sustained effects of early educational intervention. Key Words early intervention, long-term results, low birth weight, randomized controlled trial Abbreviations IHDP--Infant Health and Development Program LLBW--lighter low birth weight HLBW--heavier low birth weight INT--intervention FUO--follow-up only YRBSS--Youth Risk Behavior Surveillance System BPI--Behavior Problem Index WASI--Weschler Abbreviated Scale of Intelligence PPVT-III--Peabody Picture Vocabulary Test-Version III HSG--high school graduate CI--confidence interval LSW--low birth weight, INTENSIVE EARLY EDUCATIONAL interventions have been documented to improve the cognitive outcomes (1) and, in some cases, reduce antisocial behavior early in the school experience. (2) In several single-site, randomized [...]

Objective. Abnormalities in brain structure, cognition, and behavior have been described in children born prematurely. However, no direct in vivo evidence has yet demonstrated abnormal neural processing in these children. Our aim was to compare brain activity associated with phonologic and semantic processing of language between term and preterm children using functional magnetic resonance imaging (fMRI). Methods. fMRI scans were acquired during a passive language comprehension task in 26 preterm children at 8 years of age and in 13 term community control children who were comparable in age, sex, maternal education, and minority status. IQ was assessed using a standard measure of intelligence. Results. The pattern of brain activity identified in a semantic processing task in the preterm children closely resembled the pattern of brain activity identified in a phonologic processing task in term controls. The greater this resemblance in the preterm children, the lower their verbal comprehension IQ scores and the poorer their language comprehension during the scanning task. Conclusions. Preterm children with the poorest language comprehension seemed not to fully engage normal semantic processing pathways in a language comprehension task. These children instead engaged pathways that normal term children used to process meaningless phonologic sounds. Aberrant processing of semantic content in these preterm children may account in part for their lower verbal IQ scores. Pediatrics 2002;110:1153-1162; functional MRI, children, prematurity, cognition, outcome., Children born prematurely are known to be at risk for cognitive and behavioral problems, including lower IQ, learning disorder, thought disturbance, and excessive distractibility and hyperactivity. (1-6) Anatomic abnormalities in [...]