Gerstein Emily D, Woodman Ashley C, Burnson Cynthia, Cheng Erika R, Poehlmann-Tynan Julie
University of Missouri-St. Louis, St. Louis, MO; University of Wisconsin-Madison, Madison, WI.
University of Massachusetts-Amherst, Amherst, MA.
J Pediatr. 2017 Aug;187:111-118. doi: 10.1016/j.jpeds.2017.04.047. Epub 2017 May 19.
To examine the trajectories of internalizing and externalizing behavior problems of preterm children between 16 months and 6 years of age and predictors of trajectories, including gestational age, child dysregulation, maternal depression, socioeconomic status, and parenting.
This longitudinal study followed 148 children and their mothers from neonatal intensive care unit discharge until 6 years of age. Gestational ages ranged from 23 to 36 weeks. The study included assessment of maternal-reported behavior problems, maternal depression, neonatal and socioeconomic characteristics, and observations of dysregulated behavior and parenting. Trajectories were identified with a semiparametric group-based analytic method, and multinomial logistic regression was used to identify significant risk factors.
Three distinct trajectories for preterm children were found for both internalizing and externalizing behavior problems. For the 2 groups with greater behavior problems (groups 1 and 2), trajectories reached their peak between 24 and 36 months of age, then leveled off or decreased. Group 3 showed a stable low level of externalizing behaviors, and a low, but slightly increasing level of internalizing behaviors. Maternal depression, child dysregulation, gestational age, and socioeconomic challenges were identified as risk factors that predicted less optimal behavior problem trajectories.
Children born prematurely followed 1 of 3 distinct developmental trajectories for both internalizing and externalizing behavior problems. The most severe behavior problems started early in development and were associated with increased child dysregulation, maternal depression, and lower socioeconomic status. These findings have implications for screening and monitoring preterm children.
研究16个月至6岁早产儿内化和外化行为问题的发展轨迹，以及这些轨迹的预测因素，包括胎龄、儿童情绪调节障碍、母亲抑郁、社会经济地位和养育方式。
这项纵向研究跟踪了148名儿童及其母亲，从新生儿重症监护病房出院直至6岁。胎龄范围为23至36周。该研究包括对母亲报告的行为问题、母亲抑郁、新生儿及社会经济特征的评估，以及对情绪调节障碍行为和养育方式的观察。采用基于半参数分组的分析方法确定轨迹，并使用多项逻辑回归来识别显著的风险因素。
在内化和外化行为问题方面，均发现早产儿有三种不同的轨迹。对于行为问题较多的两组（第1组和第2组），轨迹在24至36个月龄时达到峰值，然后趋于平稳或下降。第3组表现出外化行为水平稳定较低，内化行为水平较低但略有上升。母亲抑郁、儿童情绪调节障碍、胎龄和社会经济挑战被确定为预测行为问题轨迹不太理想的风险因素。
早产儿童在内化和外化行为问题上遵循三种不同的发育轨迹之一。最严重的行为问题在发育早期就开始出现，并且与儿童情绪调节障碍增加、母亲抑郁和社会经济地位较低有关。这些发现对早产儿的筛查和监测具有重要意义。
