ORIGINAL ARTICLE

Behavioural and emotional problems in very preterm and very low birthweight infants at age 5 years

S A Reijneveld¹, M J K de Kleine², A L van Baar³, L A A Kollée⁴, C M Verhaak⁴, F C Verhulst⁵, S P Verloove-Vanhorick⁶

¹ Department of Child Health, TNO (Netherlands Organization of Applied Scientific Research) Quality of Life, Leiden, The Netherlands; Department of Health Science, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
² Department of Neonatology, Maxima Medical Centre, Veldhoven, The Netherlands
³ Department of Paediatric Psychology, Tilburg University, Tilburg, The Netherlands
⁴ Department of Paediatrics, Radboud University, University Medical Center Nijmegen, Nijmegen, The Netherlands
⁵ Department of Child and Adolescent Psychiatry, Academic Hospital Rotterdam-Sophia, Erasmus University Rotterdam, Rotterdam, The Netherlands
⁶ Department of Child Health, TNO (Netherlands Organization of Applied Scientific Research) Quality of Life; Department of Paediatrics, Leiden University Medical Center, Leiden

Correspondence to:
S A Reijneveld
Department of Health Sciences, University Medical Center Groningen, University of Groningen, PO Box 196, 9700 AD Groningen, The Netherlands; S.A.Reijneveld{at}med.umcg.nl

Background: Children born very preterm (VP; <32 weeks’ gestation) or with very low birth weight (VLBW, <1500 g; hereafter called VP/VLBW) are at risk for behavioural and emotional problems during school age and adolescence. At school entrance these problems may hamper academic functioning, but evidence on their occurrence at this age in VP/VLBW children is lacking.

Aim: To provide information on academic functioning of VP/VLBW children and to examine the association of behavioural and emotional problems with other developmental problems assessed by paediatricians.

Design, setting and participants: A cohort of 431 VP/VLBW children aged 5 years (response rate 76.1%) was compared with two large national samples of children of the same age (n = 6007, response rate 86.9%).

Outcome measures: Behavioural and emotional problems measured by the Child Behavior Checklist (CBCL), and paediatrician assessment of other developmental domains among VP/VLBW children.

Results: The prevalence rate of a CBCL total problems score in the clinical range was higher among VP/VLBW children than among children of the same age from the general population (13.2% v 8.7%, odds ratio 1.60 (95% confidence interval 1.18 to 2.17)). Mean differences were largest for social and attention problems. Moreover, they were larger in children with paediatrician-diagnosed developmental problems at 5 years, and somewhat larger in children with severe perinatal problems.

Conclusion: At school entrance, VP/VLBW children are more likely to have behavioural and emotional problems that are detrimental for academic functioning. Targeted and timely help is needed to support them and their parents in overcoming these problems and in enabling them to be socially successful.

Abbreviations: CBCL, Child Behavior Checklist; VLBW, very low birth weight; VP/VLBW, very preterm or very low birth weight

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