Long-Term Neuropsychological Outcome in Preterm Twins

Abstract

Few long-term studies have yet described neuropsychological outcome in preterm twins. Our aim was to assess, by long-term evaluation, neuropsychological outcome in preterm twins in order to define a correct follow-up program. Our study was a cohort one, with an index and a comparison group. Neonatal medical records of all preterm newborns admitted to our centre between 1991 and 1997 were reviewed and selected patients were recalled. The sample population included two matched groups of children aged 6—12 years, 86 twins and 86 singletons, submitted to paediatric, neurological, psychological, and ophthalmological examinations. Inclusion criteria were twin pregnancy and gestational age 27—36 weeks for index group; same gestational age, but single pregnancy, for the comparison group. All children underwent paediatric and neuropsychiatric examinations, cognitive assessment, and psychological evaluation by standardized tests for screening of learning specific disorders and language difficulties, and finally, ophthalmological examination. In order to study their role in predicting neuropsychological outcome, we examined some perinatal prognostic factors by statistical analysis. Unfavourable neuropsychological outcome was observed in 55/172 (32%) children, with different prevalence in the two groups, 42/172 (24%) in twins and 13/172 (8%) in singletons. Statistical analysis performed for examined prognostic factors showed significant differences in neuropsychological outcome with regard only to gestational age < 32 weeks, low birth weight, intraventricular haemorrhage, and periventricular leukomalacia. The incidence of neuropsychological diseases in the two groups showed significant difference about language and learning difficulties. Our data suggest that preterm twins represent a particular high-risk category of premature babies, mostly regarding the risk of so-called “minimal brain dysfunction”, so a careful follow-up is recommended.

The Limited Effects of Obstetrical and Neonatal Complications on Conduct and Attention-Deficit Hyperactivity Disorder Symptoms in Middle Childhood

“…However, as previous research has suggested, preterm birth and low birthweight are modest predictors of future behavioral problems, 4,5,16 even when an array of possibly confounding variables are controlled in a systematically ascertained sample.…”

“…For example, Nigg and Breslau 4 found evidence indicating a relationship between low birthweight (≤ 2500g) and ADHD based on teacher report at ages 6 and 11 years, as well as a robust effect of maternal smoking on ODD and CD. Furthermore, Iannone et al 5 found more negative neuropsychological outcomes as determined by assessments of learning and language difficulties in low birthweight (≤ 2500g) infants. In contrast, Goodman and Stevenson 6 did not find perinatal adversity, qualified by birthweight and birth order, associated with hyperactivity, and Miller et al 7 found no relationship between low birthweight (500–999g) and future behavioral difficulties at ages 5 and 8 years.…”

Prevalence and Associated Factors of Minor Neuromotor Dysfunctions at Age 5 Years in Prematurely Born Children

“…Few long-term studies on multiple births separately consider children born prematurely. A recent study 44 compared a cohort of 6-to 12-year-old twins born between 27 and 36 weeks with a control group of singletons of the same age and born at the same GA and found that the twins had a higher risk of minimal brain dysfunction. In another study 45 of 2-year-old children born before 31 weeks' GA, no significant difference in the incidence of death or severe disability was observed between twins and singletons.…”