How can premature gestational age influence the cognitive, motor and emotional development of children?

Font: 

Risk of Developmental Disorders in Children Born at 32 to 38 Weeks' Gestation: A Meta-Analysis

Neurological risk in the medium neonatal risk child

There is a clear and established relationship between premature birth and the risk of problems in neurodevelopment, or neurological development. The severity of these problems is directly related to the gestational age at birth: the lower the gestational age, the greater the risk of complications.

But what is a premature baby?

A baby born before 37 completed weeks of gestation is considered a premature baby. A normal pregnancy is considered when it goes from 38 weeks to 42 weeks of gestation.

There are many ways to calculate gestational age, but the one that is evident in the baby's development always prevails. 

• The first way to calculate gestational age is by date of last menstruation, with it we can determine the beginning of the development of the fetus and thus be able to correlate with the gestational age that we show in the fetus or baby and be able to establish if it is growing properly.
• Before birthIn check-ups during pregnancy with ultrasounds, the size of the baby's head, abdomen and femur can be measured, with which the doctor determines its growth in relation to the gestational week.
• After birth, Gestational age can be measured by observing the baby through classifications that cover parameters such as weight, height, head circumference, vital signs, reflexes, muscle tone, posture, and the condition of skin and hair, and the final gestational age is established. .

If the gestational age after birth correlates to the calendar age corresponding to the weeks of pregnancy, we can say that it is an adequate or appropriate baby for the gestational age (AGA). When the development parameters are lower than those stipulated or have lower rates, it is considered small for gestational age.

Some causes of neurodevelopmental disorders are:

• Genetic diseases.
• Hereditary metabolic diseases.
• Chromosomal abnormalities.
• Multiple pregnancy (twins, triplets or more).
• Abnormal placenta.
• High blood pressure (preeclampsia).

Premature newborns have immature brains and developing organs, making them more susceptible to brain injuries and difficulties adjusting to life outside the womb. Some of the most common neurodevelopmental problems associated with prematurity include:

• Delays in psychomotor development: Premature babies may take longer to reach typical developmental milestones, such as sitting, crawling, and walking.
• Learning and attention problems: Premature infants may have difficulty concentrating, learning, and remembering information.
• Vision and hearing problems: Premature babies are at increased risk for vision and hearing problems.
• Cerebral palsy: Cerebral palsy is a condition that affects muscle movement and coordination. It is more common in premature babies, especially those born very premature.

Research suggests that late preterm birth (between 34 and 37 weeks of gestation) may also carry neurodevelopmental risks, although these risks are generally lower than those of extremely preterm babies.

The exact causes of neurodevelopmental problems in premature babies are not completely understood, but are believed to be multifactorial. Some of the risk factors include:

• Infections during pregnancy or childbirth.
• Maternal health problems, such as diabetes, hypothyroidism or hypertension.
• Exposure to toxins, such as tobacco smoke or drugs.
• Multiple birth.

Congenital hypothyroidism is an insufficiency due to the partial or total absence of the thyroid gland or the lack of action of these hormones during the intrauterine life of the fetus. Which notably affects the development of the central nervous and skeletal system of the fetus. It has a high prevalence rate of 1 in every 4000 live births and is the most common preventable cause affecting the fetus.

In cases of gestational diabetes, they are usually macrosomic children, that is, children large for their gestational age but who, due to the metabolic alteration present and their size, have a greater probability of obstetric trauma in the birth canal, hypoglycemia, hypocalcemia and hypomagnesemia that can cause lethargy, seizures, apneas, shock and even coma.

Prenatal infections are conditions that affect the fetus in different proportions that depend on the etiological agent, and most conditions affect the nervous system such as encephalitis, meningitis or meningoencephalitis. Studies have reported that some have presented up to 30% of long-term intracranial calcifications when the etiological agent is parasitic invasion.

Other repercussions are microcephaly, hydrocephalus, chorioretinitis in up to 70% of cases of infections in the first trimester by Toxoplasma gondii with serious consequences on the neurodevelopment of the baby.

Syphilis in its congenital form affects 1 in 10 live births, as a consequence we will have a premature baby with restriction and/or delay in intrauterine growth, nephrotic syndrome, pneumonia, hepatosplenomegaly, conjunctivitis, lymph nodes and hemolytic anemia. This is not immediate at birth, it is expressed throughout the weeks to months after birth, and some symptoms can be observed progressively even at 2 years of life.

Another of the infections that greatly affects is HIV/AIDS when children are infected, damaging between 15 to 25% of children with lesions at the level of the central nervous system, affecting motor skills, visuo-motor integration and visuospatial perception and , to a lesser extent, of language.

Perinatal asphyxia is a leading cause of perinatal morbidity and mortality. Brain injury from perinatal asphyxia is due to cerebral hypoxia and ischemia that ultimately lead to brain dysfunction and neuronal death. Its incidence varies with gestational age, being 0.5% in the full-term newborn, while in the newborn less than 30 weeks the figure rises to 50%. Long-term manifestations present as motor sequelae (with various forms of cerebral palsy), cognitive, epilepsy and neurosensory deficits. The intensity and duration of clinical symptoms also have prognostic value, mainly if seizures or coma occurred.

Intrauterine growth retardation

Intrauterine growth retardation is another adverse condition during fetal life that has been related to structural and functional changes in neurodevelopment from the neonatal period to adolescence. Children with intrauterine growth retardation usually present with perinatal asphyxia, meconium aspiration, hypocalcemia, hypothermia, polycythemia, congenital malformations, and infections.

In addition to neonatal morbidity, delay can produce alterations in neuropsychic development; Both symmetrical and asymmetrical can alter neurodevelopment. In general, there is a worse prognosis in cases of symmetrical intrauterine growth retardation, linked to injuries during early gestation. 

However, many events associated with neurodevelopment occur in late gestation. These include: glial proliferation, neuronal migration, cortical differentiation and organization, and connectivity between different brain structures. Thus, neonates with intrauterine growth retardation may present either subtle sequelae or more important neurodevelopmental abnormalities. 

The most observed problems in these children include dysfunctions of fine and gross motor skills, individual behavior (attention deficit, hyperactivity) and social, and cognitive level. In this regard, it has been reported that school-age children, born small for gestational age with moderate intrauterine growth retardation, had a greater risk of cognitive and behavioral difficulties than those appropriate for gestational age. 

Therefore, the relationship between cognitive function and intrauterine growth retardation has also been studied in adults born with such retardation, who achieved significantly lower IQ scores than their peers without intrauterine growth retardation.

Fortunately, most premature babies develop normally and reach the same developmental milestones as full-term babies. However, some premature babies may need developmental therapy, special education, or other support services to help them reach their full potential.

Early intervention is essential for premature babies at risk for neurodevelopmental problems. Early intervention programs can help babies develop motor, cognitive, language, and social skills.

If you have a premature baby, it's important to talk to your pediatrician about the risks of neurodevelopmental problems and early intervention options.

The relationship between premature gestational age and risk in neurodevelopment is a complex and multifaceted topic that has been the subject of study and research in the field of medicine and public health. Prematurity, defined as birth before 37 weeks of gestation, is a known risk factor for a wide range of health complications, including neurodevelopment.

Prematurity can be caused by a variety of factors, including maternal health problems, genetics, stress, exposure to environmental toxins, and lack of access to appropriate medical care. These factors can contribute to premature birth and consequently increase the risk of complications for the baby, including neurodevelopment.

Neurodevelopment refers to the process by which the nervous system develops and matures, including the formation of brain structures, neural connections, and cognitive functions. Prematurity can interfere with this process, as the baby's brain may not have had enough time to fully develop in the womb. This can lead to a series of short and long-term health problems, which can affect the child's cognitive, motor and emotional development.

Numerous studies have shown that children born prematurely have a higher risk of neurodevelopmental problems compared to children born full term. These problems may include delays in cognitive development, learning difficulties, autism spectrum disorders, attention deficit hyperactivity disorder (ADHD), cerebral palsy, and behavioral problems. Additionally, prematurity has also been associated with an increased risk of developing psychiatric disorders in adulthood, such as depression and anxiety.

The relationship between prematurity and risk in neurodevelopment may be influenced by a number of factors, including both biological and environmental factors. Biological factors may include immaturity of the central nervous system, exposure to adverse conditions in utero, and the need for intensive medical interventions after birth. Environmental factors may include the quality of neonatal medical care, the family and social environment, and access to adequate resources and support.

Additionally, prematurity can have a significant impact on the quality of life of children and their families. Parents of premature children often face emotional, financial, and logistical challenges as they must deal with the demands of intensive medical care, concerns about their child's development, and the need to balance caring for a premature child with other family responsibilities. and labor.

Despite these challenges, it is important to note that not all preterm children experience neurodevelopmental problems. Many premature infants develop without significant problems and lead healthy, productive lives. However, it is crucial to understand the risk factors and potential consequences of prematurity to identify those children who may need additional support and early intervention services.

In terms of intervention and prevention, there are several strategies that can help mitigate the risk of neurodevelopmental problems in premature children. These strategies may include improving prenatal care to reduce the risk of preterm birth, developing high-quality neonatal care programs, accessing early intervention services for preterm infants, and ongoing support for families of preterm infants.

Continued research in this field is essential to better understand the underlying mechanisms that link prematurity to risk in neurodevelopment, as well as to develop effective interventions that can improve outcomes for preterm children and their families.

Given the multifactorial nature of developmental delay, it is necessary to identify possible intervention factors. The need to provide preventive prenatal care is well known, through adequate monitoring of the pregnancy by the health team, but more and more work is also being done in relation to the care of the child once admitted to the Intensive Care Unit. Neonatal, through so-called "developmentally focused care", whose main objective is the protection of the brain. 

Then the neurological risk neonate is defined as «that child who, due to his or her pre, peri or postnatal history, is more likely to manifest cognitive, motor, sensory or behavioral development problems in the first years of life, which may be transitory or permanent.«. 

They initially present inapparent brain damage, with a symptom-free period that will depend on the technological means to detect them, eventually followed by one or more clinical manifestations.

Children who finally develop symptoms can present two types of neurological sequelae: those that are expressed in the first year of life and that can be mild, moderate or severe; and other later ones, which are detected at school age. This last group is generally characterized by difficulties in school learning, behavioral disorders, motor clumsiness, language delay or problems in social adaptation.

These more “qualitative” characteristics are expressed phenotypically on a continuous scale, where neurodevelopmental disorders are located on a spectrum that runs from normality to pathology. It will then be necessary to monitor these neonates from the point of view of neurodevelopment, which, as mentioned, begins at a first level with the investigation of neurodevelopment through different scales by the pediatrician.

Once the investigation has been carried out, it will be necessary to refer the child with positive results to a specialist for a definitive diagnosis and to begin the corresponding treatment. Eventually, the subsequent development of the child will require considering other factors that have been recognized as protective or stimulating of child development, such as the promotion of breastfeeding, adequate nutrition, maternal education and early stimulation, among others. 

The relationship between prematurity and risk in neurodevelopment is a complex and multidisciplinary area that requires a deep understanding of the biological, environmental and social factors that influence the development of premature children. Through research, education, and quality health care, it is possible to mitigate the risks associated with prematurity and improve outcomes for children born prematurely.

The increase in prenatal controls is of utmost importance, the reduction of preterm births and cesarean section births seem to be of fundamental importance in this period. After delivery, it is necessary to control the neurological risk factors, taking extreme care of the newborn in the Neonatal Intensive Care Unit, especially for that group of children with inapparent disorders such as medium-risk newborns.

On our blog we have articles related to neurology and neurodevelopmental disorders, as well as news and scientific advances that might interest you, just enter from the following link: https://eneviahealth.com/blog/

We also have a YouTube channel where you can find interviews and videos from different professionals and specialists in different health areas related to neurological, immune and genetic development: https://www.youtube.com/@EneviaHealth/videos