Torstein Vik

Psychiatric symptoms and disorders in adolescents with low birth weight.

Objective: To evaluate the prevalence of psychiatric symptoms and disorders associated with low birth weight. Design/study groups: A population based follow up study of 56 very low birthweight (VLBW: birth weight ⩽ 1500 g), 60 term small for gestational age (SGA: birth weight < 10th centile), and 83 term control (birth weight ⩾ 10th centile) children at 14 years of age. Outcome measures: Schedule for affective disorders and schizophrenia for school aged children, attention deficit/hyperactivity disorder (ADHD) rating scale IV, autism spectrum screening questionnaire, and children’s global assessment scale. Results: VLBW adolescents had a higher prevalence of psychiatric symptoms (46%) than controls (13%) (odds ratio (OR) 5.7, 95% confidence interval (CI) 2.5 to 13.0) and more psychiatric disorders (25%) than controls (7%) (OR 4.3, 95%CI 1.5 to 12.0), especially anxiety disorders. Although 25% of the VLBW adolescents had attention problems, ADHD was diagnosed in only 7%. Four VLBW adolescents had symptoms of Asperger’s disorder, and the VLBW group had a higher sum score than controls on the autism spectrum screening questionnaire. Although more SGA adolescents had psychiatric symptoms than controls (23% v 13%), the difference was not statistically significant. Results remained essentially the same when adolescents with low estimated intelligence quotient were excluded, and persisted after possible psychosocial confounders had been controlled for. Conclusion: VLBW, but not SGA adolescents, have a high risk of developing psychiatric symptoms and disorders by the age of 14, especially attention deficit, anxiety symptoms, and relational problems.

Pre- and post-natal growth in children of women who smoked in pregnancy.

Pre- and post-natal growth was studied from week 17 of pregnancy until 5 years of age in children of women who reported daily smoking at the time of conception, and compared to the growth in children of non-smokers. Fetal abdominal diameter, femur length and biparietal diameter were measured in weeks 17 and 37 of pregnancy, and weight, height and head circumference were measured at birth, and at 6, 13 and 60 months of age in 185 children of smokers and 345 children of non-smokers. Cross sectional data at birth showed that infants of smokers had lower weight and length, but similar ponderal index as infants of non-smokers and this may suggest a symmetrical growth retardation. Longitudinal growth curves indicated that the growth retardation took place in the second half of pregnancy. During the first 5 years of life, children of smokers had complete catch-up growth in weight, a partial catch-up in height, and no catch-up growth in head circumference. At 5 years, children of smokers had a higher ponderal index and skinfold thickness, suggesting that these children, on average, were more obese than children of non-smokers.

Breast feeding and cognitive development at age 1 and 5 years

AIM To examine whether duration of breast feeding has any effect on a childs cognitive or motor development in a population with favourable environmental conditions and a high prevalence of breast feeding. METHODS In 345 Scandinavian children, data on breast feeding were prospectively recorded during the first year of life, and neuromotor development was assessed at 1 and 5 years of age. Main outcome measures were Bayleys Scales of Infant Development at age 13 months (Mental Index, MDI; Psychomotor Index, PDI), Wechsler Preschool and Primary Scales of Intelligence (WPPSI-R), and Peabody Developmental Scales at age 5. RESULTS Children breast fed for less than 3 months had an increased risk, compared to children breast fed for at least 6 months, of a test score below the median value of MDI at 13 months and of WPPSI-R at 5 years. Maternal age, maternal intelligence (Raven score), maternal education, and smoking in pregnancy were significant confounders, but the increased risk of lower MDI and total IQ scores persisted after adjustment for each of these factors. We found no clear association between duration of breast feeding and motor development at 13 months or 5 years of age. CONCLUSION Our data suggest that a longer duration of breast feeding benefits cognitive development.

Psychiatric symptoms in low birth weight adolescents, assessed by screening questionnaires

ObjectiveThe aim of this study was to explore psychiatric symptoms in low birth weight adolescents, and the usefulness of questionnaires compared with psychiatric interview.Design/study groupsA population-based follow-up study of 56 very low birth weight (VLBW), 60 term small for gestational age (SGA) and 83 control adolescents at 14 years of age was made.Outcome measuresThe Achenbach System of Empirically Based Assessment (ASEBA) and the Strengths and Difficulties Questionnaire (SDQ) were rated by adolescents, parents and teachers. The results were compared with diagnostic assessment based on the semi-structured interview, Schedule for Affective Disorders and Schizophrenia for School Aged Children (K-SADS).ResultsVLBW adolescents had more psychiatric symptoms than controls, especially attention deficit, emotional, behavioural, social and also academic problems. Although less consistent, the SGA group had more emotional, conduct and attention deficit symptoms than controls. Results remained essentially the same when adolescents with low estimated IQ were excluded, and persisted after controlling for possible confounders. The sensitivity and specificity of ASEBA and SDQ differed between informants and groups.ConclusionVLBW adolescents are at risk of developing psychiatric symptoms, and reduced social and academic skills by the age of 14. Term SGA adolescents may have discrete emotional, behavioural and attention deficit symptoms. ASEBA and SDQ provide a useful supplement to psychiatric interview.

Effect of breastfeeding on cognitive development of infants born small for gestational age

Breastfeeding during infancy appears to result in enhanced cognitive development during childhood, but it is not known whether breastfeeding should be encouraged for infants born small for gestational age (SGA) whose growth might otherwise benefit from nutritional supplementation. To address this issue, duration of exclusive breastfeeding and cognitive development were evaluated prospectively for 220 term children born SGA and 299 term children born appropriate for gestational age (AGA). Cognitive development was assessed using the Bayley Scale of Infant Development at 13 mo and Wechsler Preschool and Primary Scales of Intelligence at 5 y of age. Infants born SGA were given supplemental foods significantly earlier than those born AGA. Growth of infants born SGA was not related to early nutritional supplementation. The salutary effect of exclusive breastfeeding on cognitive development was greater for children born SGA than for those born AGA. Based on a linear association between duration of exclusive breastfeeding and intelligence quotient (IQ), children born SGA and exclusively breastfed for 24 wk were predicted to have an 11‐point IQ advantage over those breastfed for 12 wk, as opposed to a 3‐point advantage for children born AGA with similar durations of breastfeeding. The IQ distribution of children born SGA and exclusively breastfed for more than 12 wk was not different from that of all children born AGA.

Effects of preterm birth and fetal growth retardation on cardiovascular risk factors in young adulthood

BACKGROUND The association between low birth weight (LBW) and increased risk of obesity, hypertension and cardiovascular disease later in life is well documented in epidemiological studies. However, clinical follow-up studies of LBW populations have only partly supported this. AIMS Evaluate associations between LBW and body fat, blood pressure (BP), lung and endothelial function, and maximal oxygen uptake (VO(2max)) in 18 year old young adults. SUBJECTS Thirty-seven subjects born prematurely with birth weight <1501 g (VLBW group), 47 born at term with low weight (<10th centile) for gestational age (SGA group) and 63 controls with normal birth weight participated in the study. OUTCOME MEASURES Anthropometric measurements, BP, endothelial function, lung function and VO(2max) were recorded. RESULTS Both LBW groups were shorter, lighter, had smaller head circumference and higher subscapular-to-triceps skinfold-ratio than controls. Systolic and mean arterial BP was higher in the VLBW compared with the control group, whereas there were no differences between the groups in endothelial function. The VLBW group had reduced dynamic lung volumes lower carbon monoxide transfer factor and lower VO(2max) compared with controls. In particular young adults born VLBW who were also growth retarded in utero had higher indices of central body fat, higher BP and lower VO(2max). CONCLUSION We found that very preterm birth, but not growth retardation at term, was associated with higher BP and a less favourable fat distribution. In particular, the young adults born VLBW who were also growth retarded in utero had less favourable outcomes.

Perinatal risk and psychiatric outcome in adolescents born preterm with very low birth weight or term small for gestational age.

Objective: To study perinatal risk factors for psychiatric symptoms in adolescents born preterm with very low birth weight or at term, but small for gestational age (GA). Method: Mental health was assessed in 65 adolescents born with very low birth weight (VLBW) (birth weight ≤1500 g), 59 born term small for GA (birth weight <10th centile) and 81 control adolescents using Schedule for Affective Disorders and Schizophrenia for School-Age Children, Childrens Global Assessment Scale, Autism Spectrum Screening Questionnaire, Attention-Deficit Hyperactivity Disorder-Rating Scale IV and Achenbach System of Empirically Based Assessment. Perinatal data included birth weight, GA, head circumference, Apgar scores, intraventricular hemorrhage, days in neonatal intensive care unit, and days on mechanical ventilation. Results: In the very low birth weight group, lower birth weight was associated with inattention (p < .01), psychiatric diagnoses, and reduced psychosocial function (p ≤ .05). Intraventricular hemorrhage increased the risk for a high inattention score (odds ratio = 7.5; 95% confidence intervals: 1.2–46.8). Lower Apgar score at 1 min was associated with a high Autism Spectrum Screening Questionnaire score and lower Apgar score at 5 min with a high internalizing score (p ≤ .05). In the subgroup born appropriate for GA, internalizing symptoms were also associated with lower GA. In the term small for GA group, perinatal events were not associated with psychiatric problems. In contrast, low socioeconomic status was associated with externalizing symptoms. Conclusion: Lower birth weight, shorter gestation, and intraventricular hemorrhage were risk factors for psychiatric problems in the very low birth weight group. Lower Apgar score increased the risk for autism spectrum symptoms and internalizing symptoms. Among adolescents born term small for GA, the main risk factor for psychiatric symptoms was low socioeconomic status.

Prenatal smoking exposure and psychiatric symptoms in adolescence

Aim: Explore associations between smoking in pregnancy and psychiatric symptoms in the adolescent offspring.

Cognitive profile in young adults born preterm at very low birthweight

Aim  The aim of this study was to assess cognitive function at the age of 19 years in individuals of very low birthweight (VLBW; ≤1500g) and in term‐born comparison individuals.

Computerized Working Memory Training Improves Function in Adolescents Born at Extremely Low Birth Weight

OBJECTIVE To evaluate the effect of a computerized working memory training program on both trained and non-trained verbal aspects of working memory and executive and memory functions in extremely low birth weight (ELBW; <1000 g) infants. STUDY DESIGN Sixteen ELBW infants and 19 term-born control subjects aged 14 to 15 years participated in the training program, and 11 adolescents were included as a non-intervention group. Extensive neuropsychological assessment was performed before and immediately after training and at a 6-month follow-up examination. Both training groups used the CogMed RM program at home 5 days a week for 5 weeks. RESULTS Both groups improved significantly on trained and non-trained working memory tasks and on other memory tests indicating a generalizing effect. Working memory capacity was improved, and effects were maintained at the 6-month follow-up examination. There was no significant improvement in the non-intervention group at the 6-week follow-up examination. CONCLUSIONS The computerized training program Cogmed RM was an effective intervention tool for improving memory and reducing core learning deficits in adolescents born at ELBW.