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Prognostic Factors for Behavioral Problems and Psychiatric Disorders in Children Born Very Preterm or Very Low Birth Weight: A Systematic Review

Linsell, Louise MSc*; Malouf, Reem MD*; Johnson, Samantha PhD; Morris, Joan PhD; Kurinczuk, Jennifer J. MD*; Marlow, Neil MD§

Journal of Developmental & Behavioral Pediatrics: January 2016 - Volume 37 - Issue 1 - p 88–102
doi: 10.1097/DBP.0000000000000238
Review Article

Objective: Risk factors associated with adverse behavioral outcomes in very preterm (VPT) or very low birth weight (VLBW) infants are poorly understood. The aim of this article is to identify prognostic factors for behavioral problems and psychiatric disorders in children born ≤32 weeks gestational age or with birth weight ≤1250 g.

Method: A systematic review was conducted using MEDLINE, Embase, and Pyscinfo databases to identify studies published between January 1, 1990 and June 1, 2014 reporting multivariable prediction models for behavioral problems or psychiatric disorders in VPT/VLBW children. Fifteen studies were identified and 2 independent reviewers extracted key information on study design, outcome definition, risk factor selection, model development, reporting, and conducted a risk of bias assessment.

Results: The 15 studies included reported risk factor analyses for the following domains: general behavioral problems (n = 8), any psychiatric disorder (n = 2), autism spectrum symptoms/disorders (n = 5), and attention deficit/hyperactivity disorder (n = 1). Findings were inconclusive because of the following: small number of studies in each domain, heterogeneity in outcome measures, lack of overlap in the risk factors examined, and differences in strategies for dealing with children with neurological impairments.

Conclusion: There is a lack of evidence concerning risk factors for behavior problems and psychiatric disorders among VPT/VLBW survivors. This review has identified the need for further research examining the etiology of disorders of psychological development in the VPT/VLBW population to refine risk prediction and identify targets for intervention. Large well-conducted studies that use standard diagnostic evaluations to assess psychiatric disorders throughout childhood and adolescence are required.

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*National Perinatal Epidemiology Unit (NPEU), Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom;

Department of Health Sciences, University of Leicester, Leicester, United Kingdom;

Queen Mary University of London, Centre for Environmental and Preventive Medicine, Barts and The London School of Medicine and Dentistry, London, United Kingdom;

§Department of Neonatology, Institute of Women's Health, University College London, London, United Kingdom.

Address for reprints: Louise Linsell, MSc, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Rd Campus, Headington, Oxford OX3 7LF, United Kingdom; e-mail:

This article presents independent research funded by the National Institute for Health Research (NIHR). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

Supported by a NIHR Doctoral Research Fellowship Award, NIHR-DRF-2012-05-206.

Disclosure: The authors declare no conflict of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Received June , 2015

Accepted October , 2015

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