Moderately preterm children need attention! Behavior and development of moderately preterm children at toddler age

Every year, more than 10.000 children in the Netherlands are born moderately preterm after 32 to 36+6 weeks of gestation, which is 6.1% of all births. These children are at risk for difficulties on the short and long term. Previous studies especially found academic problems and difficulties in attention. Although there was increasing interest in the development of moderately preterm children during the last decade, still little was known about the early development and functioning of these children at toddler age. Aims of the current dissertation were to study differences in behavior, development and attention capacities between moderately preterm and term born children at toddler age. Furthermore, the role of biological factors, child characteristics, and maternal stimulation on the cognitive development of moderately preterm and term born children was investigated. To accomplish these aims, a group of 123 moderately preterm and 103 term born children was studied longitudinally at 12, 18, and 24 months of age, corrected for weeks of prematurity.

At 24 months corrected age, moderately preterm children showed more internalizing behavior problems and less receptive language skills than the term born children. Differences regarding cognitive, motor, and expressive language functioning were only found when age was not corrected for prematurity.

In order to perform a detailed study of attention capacities of toddlers, a new instrument was designed: The Utrecht Tasks for Attention in Toddlers using Eye-tracking (UTATE). The UTATE consists of four tasks measuring functioning of the orienting, alerting, and executive attention systems with an eye tracker. Results showed that at 18 months of age, moderately preterm children performed worse on orienting and alerting skills compared to term born peers. Furthermore, a larger subgroup of preterm children showed suboptimal functioning concerning alerting. This indicates that moderately preterm children especially seem to have difficulties with sustaining their attention for a longer period of time.

An integrated model examined how cognitive functioning at 24 months of age was predicted by the child’s gestational age, and attention capacities and maternal stimulation at 18 months of age. An indirect relation between gestational age and cognitive functioning was found through maternal behavior and attention skills of the children: Lower gestational age was related to more maternal behavior redirecting the children’s attention, which was related to less orienting and alerting attention skills, that in turn predicted lower cognitive scores of the children at two years of age. In addition, more maternal attempts to maintain the attention of their children were related to better cognitive scores at two years of age.

In conclusion, these studies showed that moderately preterm children are at increased risk for internalizing behavior problems, for less developed receptive language skills, and for difficulties in sustaining attention for a longer period of time as early as toddler age. In addition, it was found that a cascade of biological risk, maternal stimulation, and attention capacities of the children was associated with cognitive outcome of the children at two years of age. The studies in this dissertation showed that moderately preterm children need attention!