Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.
Psychogical Sciences, University Missouri, St. Louis, MO, USA.
J Child Psychol Psychiatry. 2020 Feb;61(2):157-166. doi: 10.1111/jcpp.13116. Epub 2019 Aug 26.
Very preterm (VPT; <30 weeks gestation) children are a heterogeneous group, yet the co-occurrence of psychiatric and neurodevelopmental impairments remains unclear. Moreover, the clinical and socio-environmental factors that promote resilient developmental outcomes among VPT children are poorly understood.
One hundred and twenty five children (85 VPT and 40 full-term) underwent neurodevelopmental evaluation at age 5-years. Parents and teachers completed measures of internalizing, externalizing, attention-deficit/hyperactivity (ADHD), and autism symptoms. Psychiatric and neurodevelopmental measures were analyzed using Latent Profile Analysis. Multinomial regression examined the extent that infant, sociodemographic, and family factors, collected prospectively from birth to follow-up, independently differentiated resilient and impaired children.
Four latent profiles were identified, including a Typically Developing Group which represented 27.1% of the VPT group and 65.0% of the full-term group, an At-Risk Group with mild psychiatric and neurodevelopmental problems (VPT 44.7%, full-term 22.5%), a Psychiatric Group with moderate-to-severe psychiatric ratings (VPT 12.9%, full-term 10.0%), and a school-based Inattentive/Hyperactive Group (VPT 15.3%, full-term 2.5%). Clinical diagnoses were highest among the Psychiatric Group (80%). Factors that differentiated resilient and impaired subgroups of VPT children included prolonged exposure to maternal psychosocial distress (p ≤ .04), current family dysfunction (p ≤ .05), and maternal ADHD symptoms (p ≤ .02), whereas social risk index scores differentiated resilient and impaired full-term children (p < .03).
Lower levels of maternal distress, family dysfunction, and maternal ADHD symptoms were associated with resilience among VPT children. Maternal distress and family dysfunction are modifiable factors to be targeted as part of psychiatric interventions embedded in the long-term care of VPT children.
极早产儿（VPT；<30 孕周）是一个异质群体，但精神和神经发育障碍的共病情况尚不清楚。此外，促进 VPT 儿童发展恢复力的临床和社会环境因素也知之甚少。
125 名儿童（85 名 VPT 和 40 名足月）在 5 岁时进行神经发育评估。父母和老师完成了内化、外化、注意力缺陷/多动障碍（ADHD）和自闭症症状的测量。使用潜在剖面分析对精神和神经发育测量结果进行分析。多项回归分析了从出生到随访期间前瞻性收集的婴儿、社会人口统计学和家庭因素在多大程度上能够区分有恢复力和有损伤的儿童。
确定了四个潜在的特征群，包括一个典型的发展组，代表 VPT 组的 27.1%和足月组的 65.0%，一个有轻度精神和神经发育问题的风险组（VPT 组 44.7%，足月组 22.5%），一个有中度至重度精神科评定的精神病组（VPT 组 12.9%，足月组 10.0%）和一个基于学校的注意力不集中/多动组（VPT 组 15.3%，足月组 2.5%）。精神病组的临床诊断率最高（80%）。区分 VPT 儿童有恢复力和有损伤亚组的因素包括母亲心理社会压力的延长暴露（p≤0.04）、当前家庭功能障碍（p≤0.05）和母亲 ADHD 症状（p≤0.02），而社会风险指数评分则区分了有恢复力和有损伤的足月儿童（p<0.03）。
较低水平的母亲压力、家庭功能障碍和母亲 ADHD 症状与 VPT 儿童的恢复力相关。母亲压力和家庭功能障碍是可以改变的因素，应作为 VPT 儿童长期护理中精神干预的一部分加以针对。
