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Very low birthweight predicts mental health problems many years later

Key clinical point: Clinicians should routinely follow children born at very low birthweight and promote early environmental enrichment for them.

Major finding: In all, 32% of the VLBW cohort had a mental health diagnosis on the DAWBA, compared with 14% of normal-birthweight controls (P < .03).

Data source: Prospective cohort study of 64 children born at very low birthweight (< 1,500 g) and 51 healthy controls.

Disclosures: Shire provided research support. The researchers reported having advisory board relationships with Shire and receiving conference and travel support from the company. They declared no other conflicts of interest.


 

AT THE AACAP ANNUAL MEETING

References

SAN DIEGO– Children of very low birthweight had higher rates of mental health disorders 10 to 14 years later than did age-matched controls, but teachers generally did not detect these differences, and instead their mental health assessments were associated with children’s socioeconomic status, a prospective study found.

The finding “has implications for mental health service access” and shows that teachers need education about the long-term mental health risks faced by very-low-birthweight (VLBW) children, said Dr. Fiona McNicholas, a visiting professor at Stanford (Calif.) University, and her associates. Clinicians should routinely follow VLBW children and should promote early environmental enrichment for these children, the investigators said at the annual meeting of the American Academy of Child and Adolescent Psychiatry.

Dr. McNicholas and her associates studied 65 children in Dublin, Ireland, who averaged 11.6 years of age (range, 10-14 years) and had weighed less than 1,500 g, or 3.3 pounds, at birth. The investigators matched each VLBW child with the next child born in the same maternity ward who was of normal birthweight and the same sex. Children, their parents, and their teachers all responded to the Strengths & Difficulties Questionnaire (SDQ, http://www.sdqinfo.com/) regarding the children. The investigators also assessed the children using the Developmental Well-Being Assessment (http://www.dawba.com/), they said.Almost one-third (32%) of the VLBW cohort had a mental health diagnosis on the DAWBA, which resembled findings from a recent study in Norway (http://www.ncbi.nlm.nih.gov/pubmed/22752364), reported Dr. McNicholas, also a professor of psychiatry at University College, Dublin. In contrast, only 14% of controls had a DAWBA diagnosis (P = .03), they said.

The rate of abnormal or clinical scores on the SDQ also was four to five times greater for VLBW children, compared with controls, based on child self-report (20% vs. 4%; P = .028) and parental report (32% vs. 8%; P = .007). Teachers “generally underreported pathology,” the investigators said, so scoring between the two groups (8% vs. 2%; P = .463) while large did not achieve statistical significance. The most common diagnosis was attention-deficit/hyperactivity disorder, which affected 17% of VLBW children and 8% of controls, the researchers added. Anxiety disorders were also common, and rates were slightly higher in VLBW children (12.5%) than among controls (9.8%).

In an analysis of variance test, teachers’ assessments of total SDQ scores depended on children’s socioeconomic status (P < .05) but not on birthweight, IQ score, or gender, reported Dr. McNicholas and her associates. “Initial investment needs to be met with ongoing surveillance and psychoeducation to ensure that disorders are recognized early and offered appropriate interventions,” the investigators concluded.

The overall rate of consent to participate among VLBW children was only 50%, and participants were of higher socioeconomic status than were nonparticipants (P < .001), the researchers noted.

Shire supported the research. The investigators reported advisory board relationships with Shire and received conference and travel support from the company. They declared no other conflicts of interest.

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