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Early Emergence of Delayed Social Competence in Infants Born Late and Moderately Preterm

Johnson, Samantha PhD, CPsychol, AFBPsS*; Matthews, Ruth MSc*; Draper, Elizabeth S. PhD*; Field, David J. DM*; Manktelow, Bradley N. PhD*; Marlow, Neil DM, FMedSci; Smith, Lucy K. PhD*; Boyle, Elaine M. MD, PhD*

Journal of Developmental & Behavioral Pediatrics: November/December 2015 - Volume 36 - Issue 9 - p 690–699
doi: 10.1097/DBP.0000000000000222
Original Articles

Objective: To assess behavioral outcomes and social competence at 2 years of age in infants born late and moderately preterm (LMPT; 32–36 wk gestation).

Method: One thousand one hundred and thirty LMPT infants and 1255 term-born (≥37 wk) controls were recruited at birth to a prospective geographical population-based study. Parents completed the Brief Infant and Toddler Social Emotional Assessment (BITSEA) at 2 years corrected age to assess infants' behavior problems and social competence. Cognitive development was assessed using the Parent Report of Children's Abilities-Revised. Parent questionnaires at 2 years were completed for 638 (57%) LMPT and 765 (62%) term-born infants. Group differences in the prevalence of behavior problems and delayed social competence between LMPT infants and term-born controls were adjusted for age, sex, small-for-gestational-age, socioeconomic status and cognitive impairment.

Results: Late and moderately preterm infants were at significantly increased risk of delayed social competence compared with term-born controls (26.4% vs 18.4%; adjusted-relative risk [RR] 1.28; 95% CI, 1.03–1.58), but there was no significant group difference in the prevalence of behavior problems (21.0% vs 17.6%; adjusted-RR 1.13, 0.89–1.42). Non-white ethnicity (RR 1.68, 1.26–2.24), medium (RR 1.60, 1.14–2.24) and high (RR 1.98, 1.41–2.75) socioeconomic risk and recreational drug use during pregnancy (RR 1.70, 1.03–2.82) were significant independent predictors of delayed social competence in LMPT infants.

Conclusion: Birth at 32 to 36 weeks of gestation confers a specific risk for delayed social competence at 2 years of age. This may be indicative of an increased risk for psychiatric disorders later in childhood.

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

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

Address for reprints: Samantha Johnson, PhD, CPsychol, AFBPsS, Department of Health Sciences, University of Leicester, 22-28 Princess Rd West, Leicester, LE1 6TP, United Kingdom; e-mail:

This article presents independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research (PGfAR) Programme (Grant Reference Number RP-PG-0407–10029). The views expressed are those of the author(s) and not necessarily those of the National Health Service (NHS), the NIHR or the Department of Health. N. Marlow receives a proportion of funding from the Department of Health's NIHR Biomedical Research Centres funding scheme at UCLH/UCL.

Disclosure: The authors declare no conflict of interest.

Received May , 2015

Accepted August , 2015

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