Department of Psychology, University of Southern California, Los Angeles, CA, USA.
Mothers, Babies and Women's Health Program, Mater Research Institute, Faculty of Medicine, The University of Queensland, South Brisbane, QLD, Australia.
Dev Med Child Neurol. 2021 Aug;63(8):954-962. doi: 10.1111/dmcn.14859. Epub 2021 Mar 18.
To compare the mental health and neurodevelopmental profiles of school-age children born very preterm, with and without an anxiety disorder, and to identify neonatal medical, psychosocial, and concurrent neurodevelopmental correlates.
A regional cohort of 102 (51 males, 51 females) children born very preterm (mean [SD] gestation at birth=28wks [2], range=23-31wks) was studied from birth to age 9 years alongside a comparison group of 109 (58 males, 51 females) children born at term (mean [SD] gestation at birth=40wks [1], range=38-41wks). At age 9 years, all children underwent a neurodevelopmental evaluation while parents were interviewed using the Development and Well-Being Assessment to diagnose a range of DSM-IV childhood psychiatric disorders. Detailed information was also available about the children's neonatal medical course and postnatal psychosocial environment, including maternal mental health and parenting.
At age 9 years, 21% (n=21) of very preterm and 13% (n=14) of term-born children met diagnostic criteria for an anxiety disorder. Clinically-anxious children born very preterm were characterized by higher rates of comorbid mental health (odds ratio [OR]=11.5, 95% confidence interval [CI]=3.8-34.7), social (OR=6.2, 95% CI=2.1-18.4), motor (OR=4.4, 95% CI=1.6-12.2), and cognitive (OR=2.6, 95% CI=1.0-7.0) problems than those without an anxiety disorder. Concurrent maternal mental health and child social difficulties were the strongest independent correlates of early-onset child anxiety disorders.
Children born very preterm who developed an early-onset anxiety disorder were subject to high rates of comorbid problems. Findings highlight the importance of addressing both maternal and child mental health issues to optimize outcomes in this high-risk population. What this paper adds One out of five school-age children born very preterm are likely to meet DSM-IV diagnostic criteria for an anxiety disorder. Half of these children born very preterm with an early-onset anxiety disorder have comorbid attention-deficit/hyperactivity disorder. Other neurodevelopmental correlates of early-onset anxiety disorders include lower cognitive ability, motor problems, and peer social difficulties. Concurrent maternal mental health and child social adjustment problems were the strongest correlates of early-onset anxiety disorder risk among children born very preterm.
比较患有和不患有焦虑障碍的学龄期极早产儿的心理健康和神经发育状况，并确定新生儿医疗、心理社会和并发神经发育的相关因素。
对一个区域性队列中的 102 名（51 名男性，51 名女性）极早产儿（出生时平均[标准差]胎龄为 28 周[2]，范围为 23-31 周）进行了研究，从出生到 9 岁，并与 109 名（58 名男性，51 名女性）足月出生的儿童（出生时平均[标准差]胎龄为 40 周[1]，范围为 38-41 周）进行了比较。在 9 岁时，所有儿童都接受了神经发育评估，同时父母接受了发展和健康评估访谈，以诊断 DSM-IV 儿童期精神障碍的一系列疾病。还详细了解了儿童的新生儿医疗过程和产后心理社会环境，包括产妇心理健康和育儿情况。
在 9 岁时，21%（n=21）的极早产儿和 13%（n=14）的足月出生的儿童符合焦虑障碍的诊断标准。患有临床焦虑症的极早产儿具有更高的合并心理健康问题（优势比[OR]=11.5，95%置信区间[CI]=3.8-34.7）、社交（OR=6.2，95% CI=2.1-18.4）、运动（OR=4.4，95% CI=1.6-12.2）和认知（OR=2.6，95% CI=1.0-7.0）问题的发生率，比没有焦虑障碍的儿童更高。同时存在的产妇心理健康问题和儿童社交困难是早期儿童焦虑障碍的最强独立相关因素。
患有早期焦虑障碍的极早产儿可能会出现较高的合并症发生率。这些发现强调了解决产妇和儿童心理健康问题的重要性，以优化这一高危人群的结果。本文的新增内容：五分之一的学龄期极早产儿可能符合 DSM-IV 焦虑障碍的诊断标准。这些患有极早产早期焦虑障碍的儿童中，有一半同时患有注意力缺陷/多动障碍。早期焦虑障碍的其他神经发育相关因素包括认知能力较低、运动问题和同伴社交困难。极早产儿早期焦虑障碍的最强相关因素是同时存在的产妇心理健康问题和儿童社会适应问题。
