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Behavioral Outcomes at Corrected Age 2.5 Years in Children Born Extremely Preterm

Månsson, Johanna MS; Stjernqvist, Karin PhD; Bäckström, Martin PhD


The authors omitted an Appendix acknowledging members of the Extremely Preterm Infants in Sweden Study (EXPRESS) group. It is available as supplementary material online at

Journal of Developmental & Behavioral Pediatrics. 35(9):597, November/December 2014.

Journal of Developmental & Behavioral Pediatrics: September 2014 - Volume 35 - Issue 7 - p 435–442
doi: 10.1097/DBP.0000000000000082
Original Article

Objective: This study examined a national cohort of 2.5-year-old children born extremely preterm with respect to behavioral problems from the perspective of parents and whether developmental variables mediated the effects of extreme prematurity on behavioral problems.

Methods: As a part of the Extremely Preterm Infants in Sweden Study (EXPRESS), 344 children born before 27 weeks of gestation and 338 control children were given the Cognitive, Language, and Motor Scales of the Bayley-III and the Parent report Child Behavior Checklist/1½-5 (CBCL/1½-5). CBCL/1½-5 assigns 7 syndrome scores, further classified into composite scores for internalizing and externalizing behavior as well as total problems. Group differences in behavioral difficulties and prevalence of clinical problems were calculated. Bayley-III scores were used in regression models to determine if developmental factors mediated the effects of extreme prematurity on behavioral problems, after controlling for sociodemographic factors.

Results: Preterm children had significantly higher mean T-scores on internalizing, externalizing, and total problems, as compared with the control subjects, but these were still within the average range. However, the proportion of subjects showing behavioral problems within the clinical range was significantly higher in the preterm group. Levels of cognitive, language, and motor development mediated the between-group differences in behavioral problems.

Conclusion: Our findings encourage behavioral assessments during preschool years and emphasize the importance of considering multifactorial pathways of prediction when examining prematurity outcome.

This article has supplementary material on the web site:

Department of Psychology, Lund University, Lund, Sweden.

Address for reprints: Johanna Månsson, MS, Department of Psychology, Lund University, Box 213, SE-221 00 Lund, Sweden; e-mail:

This study was supported by grants from the Swedish Research Council 2006-3855, 2009-4250, the Crafoord Foundation, the Linnéa and Josef Carlsson's Foundation, and the “Nils W Svenningsens Stiftelse för Prematurforskning.”

Disclosure: The authors declare no conflict of interest.

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Received January , 2014

Accepted June , 2014

© 2014 by Lippincott Williams & Wilkins