Cognitive and Behavioral Impairments in Preterm Children

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Table of Contents

Introduction
Background and Significance
Synthesis of Literature
Conclusion
References
Appendix A

Introduction

The purpose of this paper is to present a literature review related to cognitive and/or behavioral impairments in preterm children. A literature review matrix is presented in the Appendix. Among topics discussed as they relate to the literature review, is the background and significance of cognitive and/or behavioral impairments in preterm children.

Background and Significance

The problem of premature birth is a challenge for the health care system, as it worsens the health of the mother and child and harms public well-being. Most of the literature and research-based publications describe newborns’ physiological health while paying insufficient attention to their cognitive and behavioral characteristics. Although the topic is still being explored in both theoretical and experimental ways, there is limited data on children’s psychological problems in adulthood. It can be stated that they are more prone to social challenges, difficulty concentrating, and interpersonal crises. Several resources point to the socio-cultural background of the community and region, as well as maternal attention and sensitivity, as the main factors in the formation of cognitive and behavioral deviations among premature newborns. The main research finding based on the literature review is the lack of empirical knowledge regarding preterm birth and the psychological status of children in the future, as well as the nursing role in suppressing deviations.

Synthesis of Literature

Cognitive and Social Difficulties

The healthcare industry observes preterm birth as a multi-layered problem rooted in maternal health. Besides, reliable outcomes of the child’s cognitive and behavioral patterns remain poorly understood. It has been noted that preterm birth significantly increases the child’s risk of decreased IQ, social openness and sociability, and a willingness to share attention with others (Zmyj, Witt, Weitkämper, Neumann & Lücke, 2017). A large sample of sources was investigated, as well as psychological testing and medical records, in which preterm children showed impaired cognitive ability. In particular, joint attention abilities in social communication are significantly inferior to peers. The conclusion and author’s recommendations of this study correlate with the research of the neurobiological and psychosocial characteristics of premature infants. It has been noted that this group has complexity with goal-oriented attention due to the developmental aspects of the brain, which are commensurate with children with average global cognitive ability (Taylor & Clark, 2016). In other words, executive function, including cognitive and emotional predictors, is below healthy scores due to neonatal complications. Thus, preterm newborns experience cognitive imbalances due to neurobiological and mental complications.

Impaired brain circuits also define neurobiological abnormalities in premature infants. Studies show that this group of newborns will be less inclined to assess society objectively and be prone to bullying and abuse due to deviant cognitive abilities (Fenoglio, Georgieff & Elison, 2017). In particular, growing up in a premature child has been linked to functional brain abnormalities that generate social sensitivity and alienation. Thus, parents should be cognitively aware and have regular visits to their child psychiatrists to develop their social brain.

Behavioral Difficulties

Premature babies have behavioral deviations. In particular, they are more susceptible to psychological diseases, including central nervous system abnormalities and attention deficit hyperactivity disorder (Palumbi et al., 2018). The study included a large sample of late preterm infants, with the results supporting the hypothesis of behavioral abnormalities and long-term mental problems. Besides, the symptomatology of psychological challenges exhibits a distinct behavioral phenotype. Research shows that premature infants are more likely to show symptoms of abnormalities during the early years of life, and this trend may persist throughout psychological development (Fitzallen, Taylor & Bora, 2020). The authors point out that identifying and minimizing symptoms is complicated by a lack of knowledge and, accordingly, children exhibit behavioral deviations due to improper care.

The physiological health of preterm infants correlates with psychological and behavioral well-being. A qualitative study with a large sample showed that all subjects had the experience of treatment in the intensive care unit and had psychological difficulties due to impaired health (Polić et al., 2017). In particular, children had problems with self-esteem and objective perception of society in combination with neurobiological abnormalities. The social environment and upbringing, in turn, can correct the psychological vulnerability. It has been noted that preterm children’s psychopathology reveals mechanisms for further socio-psychological imbalance (Montagna & Nosarti, 2016). Nevertheless, the timely identification of biological and environmental markers of influence makes it possible to choose the correct methodology for long-term intervention.

Interventional Implications

The nursing role in the quality of life of premature infants is often underestimated. Research shows that this group’s physiological and cognitive impairments can be addressed and adapted through health education (Majewska, Zajkiewicz, Wacław-Abdul, Baran & Szymczyk, 2018). In particular, nurse educators can identify abnormalities and communicate information regarding care to parents. In addition to education, demographic factors such as race, gender, and ethnicity affect a child’s cognitive abilities. It has been noted that each element has a unique correlation with preterm birth in terms of behavioral and neural abnormalities, which can be analyzed in advance (Linsell, Malouf, Morris, Kurinczuk & Marlow, 2015). More extensive and longer-term medical interventions cover the educational field. In particular, nurse educators and community workers must contribute to the secondary education curriculum because of the proven difficulties of preterm children with science (Jaekel, Baumann, Bartmann & Wolke, 2019). Thus, the sphere of influence of medical specialists is not limited by the hospital walls but can accompany this group of children throughout their lives.

Gaps in Literature

The analyzed sources sufficiently describe the physiological, cognitive, behavioral, and social aspects of abnormalities in premature children. Despite theoretical adequacy, the available literature offers limited guidelines for parents in terms of lifelong childcare. In particular, ways of obtaining health education and practical methodology of influencing premature children from birth to adolescence have not been obtained. It is essential to understand that the literature gap remains significant due to the prevalence of research in physiology and psychopathology. On the other hand, this layer of information is essential as a platform for more focused empirical and evidence-based practices. Premature birth can mean insufficient neurobiological and nervous development of the body, which affects the quality of upbringing. Thus, the existing literature gap should be bridged through a focused exploration of practical ways of caring for a child, including elements of interpersonal contact with parents and interaction with the community.

Conclusion

Premature birth is a predictor of physiological, psychological, and behavioral difficulties in a child. The literature review revealed cognitive impairments, namely problems in socialization and interpersonal contact in this group. Behavioral deviations cover a propensity for low self-esteem, subsequent mental illness, and psychopathological vulnerability in society. Medical interventions have been identified as under-researched, as nurses’ and specialists’ involvement can be extended to lifelong. A literature review has shown that premature babies’ environment can positively influence symptoms and minimize cognitive barriers. Thus, current practices need to be detailed for different social and demographic groups to improve the quality of life for these children.

References

Fenoglio, A., Georgieff, M., & Elison, J. (2017). Social brain circuitry and social cognition in infants born preterm. Journal of Neurodevelopmental Disorders, 9(1).

Fitzallen, G., Taylor, H., & Bora, S. (2020). What do we know about the preterm behavioral phenotype? A narrative review. Frontiers in Psychiatry, 11.

Jaekel, J., Baumann, N., Bartmann, P., & Wolke, D. (2019). General cognitive but not mathematic abilities predict very preterm and healthy term born adults’ wealth. PLOS ONE, 14(3), e0212789.

Linsell, L., Malouf, R., Morris, J., Kurinczuk, J., & Marlow, N. (2015). Prognostic factors for poor cognitive development in children born very preterm or with very low birth weight. JAMA Pediatrics, 169(12), 1162.

Majewska, J., Zajkiewicz, K., Wacław-Abdul, K., Baran, J., & Szymczyk, D. (2018). Neuromotor development of children aged 6 and 7 years born before the 30th week gestation. Biomed Research International, 2018, 1-12.

Montagna, A., & Nosarti, C. (2016). Socio-emotional development following very preterm birth: Pathways to psychopathology. Frontiers in Psychology, 7.

Palumbi, R., Peschechera, A., Margari, M., Craig, F., Cristella, A., Petruzzelli, M., & Margari, L. (2018). Neurodevelopmental and emotional-behavioral outcomes in late-preterm infants: an observational descriptive case study. BMC Pediatrics, 18(1).

Polić, B., Bubić, A., Meštrović, J., Markić, J., Kovačević, T., & Antončić Furlan, I. et al. (2017). Emotional and behavioral outcomes and quality of life in school-age children born as late preterm: retrospective cohort study. Croatian Medical Journal, 58(5), 332-341.

Taylor, H., & Clark, C. (2016). Executive function in children born preterm: Risk factors and implications for outcome. Seminars in Perinatology, 40(8), 520-529.

Zmyj, N., Witt, S., Weitkämper, A., Neumann, H., & Lücke, T. (2017). Social cognition in children born preterm: A perspective on future research directions. Frontiers in Psychology, 8.

Appendix A

Author/Date	Theoretical/Conceptual Framework	Research Question(s)/Hypotheses	Methodology	Analysis & Results	Conclusions	Implications for Future Research	Implications for Practice
Zmyj, Witt, Weitkämper, Neumann & Lücke, 2017	Preterm newborns experience social challenges due to insufficiently developed cognitive abilities, although this is not well researched.	RQ – is there a clear correlation between preterm birth and cognitive impediments to socialization? H – Premature newborns, in most cases, have difficulty communicating and joint attention	Qualitative	Impaired cognitive abilities, social adaptation, level of IQ , and joint attention in most cases.	Despite precise results and confirmation of the initial hypothesis, it is not a definitive statement due to the lack of related research with other types of data collection in various academic, medical, and geographic settings.	Study of the Theory of Mind as a multi-hovering theory in which parents and others choose a more psychologically oriented model of communication with a child; further research on shared attention and social acceptance.	Increased involvement of nurses and health professionals in educating the mother about the infant’s potential cognitive characteristics.
Taylor & Clark, 2016	Executive function is fundamentally abnormal in premature infants due to neurobiological changes. The theoretical framework is the study of social deviations in terms of impaired cognitive abilities.	RQ – Are there practical ways to minimize neurobiological abnormalities in the social contact of premature children? H – Proper executive function can be achieved through parenting health education and supportive home and educational environment.	Qualitative	Executive impairment was analyzed through empirical research and linking the results to theoretical concepts.	Despite the proven impairment of EF in premature infants, a supportive environment around the baby will improve cognitive performance.	A more detailed study of cognitive training and beneficial parenting and peer behavior patterns.	Nurses should be involved in maternal and community health education as part of the cognitive development of children.
Fenoglio, Georgieff & Elison, 2017	Neurobiological abnormalities in preterm infants are of interest to the medical community as markers for a potentially successful intervention.	RQ – Does the deviation of the brain circuits affect social acceptance and neural development? H – Premature babies are more prone to insults and further cognitive difficulties due to neurobiological abnormalities at birth.	Field Study	The concept of a social brain is inextricably linked with brain circuits, with both cognitive sets impaired by the premature baby’s nerve damage.	More detailed studies are needed for this conclusion, which will examine specific ubiquitous scenarios and their effects on the nervous system.	Empirical studies with several groups of premature and term infants.	Cognitive training as a way of a child’s psychological development.
Palumbi et al., 2018	Studied behavioral deviations in preterm children may correlate with further psychological difficulties.	RQ – Are premature babies at increased risk of developing mental illness? H – Premature babies are more prone to behavioral deviations due to neurobiological and neural abnormalities.	Qualitative (field research).	Exploring the psychological and emotional-cognitive abilities of the 68 LPI through medical records and tests.	Premature children are more prone to psychological diagnoses due to deviations of the nervous system and late diagnosis.	Further research should trace the long-term relationship between different medical intervention settings.	Parents and the community must be aware of the markers of mental illness to adopt timely long-term therapy.
Fitzallen, Taylor & Bora, 2020	Studying behavioral and symptomatic deviations in premature infants can provide an impetus for long-term therapy to support optimal emotional and social skills.	RQ – to what extent does the correlation between behavioral disorders and preterm birth cause mental illness in the future? H – Adequate knowledge of the symptoms in the group will help prevent social disability.	Qualitative	A literature review of the empirical evidence demonstrated the behavioral phenotype of preterm infants with associated markers of disease susceptibility.	Timely identification of symptoms will allow correcting the characteristics of the phenotype.	Empirical studies of behavioral phenotype and review of various cognitive training techniques.	Nursing impact on health education of parents and the community within the framework of symptomatology.
Polić et al., 2017	Examining the behavioral and psychological well-being of premature babies through the lens of physiological health can be knowledge about caring for them.	RQ – Is there a correlation between physiological and behavioral well-being, and how does this affect socialization?	Qualitative (field research)	The test group is experiencing a social predicament due to low self-esteem and behavioral deviations.	Premature babies must have a specific environment in which their health will be continuously maintained.	Investigation of the correlation between specific physiological diagnoses and behavioral deviations.	Regular psychiatric check-ups and adaptation of the environment.
Montagna & Nosarti, 2016	Biological and social markers can influence the behavioral growth of premature infants.	RQ – what role does the identification of psychopathology play in the adaptation of interventional techniques?	Qualitative	The identified mechanisms are biological and social vulnerability and methods of education.	Current structural-developmental modalities must be adapted for these three markers to provide the behavioral correction.	Empirical research in each of the three sections.	Early identification of living conditions and social environment for the adaptation of psychological therapy for the child.
Majewska, Zajkiewicz, Wacław-Abdul, Baran & Szymczyk, 2018	Parental knowledge and regular medical care can minimize physiological abnormalities by adapting the environment and exercise.	RQ – can healthcare professionals adapt the environment of children with impaired neuromotor function in the long term?	Qualitative	Neuromotor abnormalities are noticeable in the majority of the sample. Parent and community health education will help improve the quality of life of these children.	Health care professionals are providers of knowledge to parents and can adjust the child’s environment for better patterns of daily routine.	Further research between specific neuromotor abnormalities and caring patterns.	Improving parenting health education and ongoing communication with pediatric nurses.
Linsell, Malouf, Morris, Kurinczuk & Marlow, 2015	Demographic factors can be predictors of the cognitive health of premature children.	RQ – do race, gender, and ethnicity affect specific psychological and neural disorders?	Qualitative	Each of the factors studied showed an impact on the cognitive development of children.	Long-term results can be achieved with quality prenatal diagnosis and consultation with doctors.	A detailed study of each factor within the framework of this study.	Developing care practices within each demographic set.
Jaekel, Baumann, Bartmann & Wolke, 2019	Neonatal risk affects cognitive and intellectual performance, but the link between this and the educational program is still being investigated	RQ – how dramatically science and neurobiological abnormalities affect the overall quality of life?	Qualitative	Mathematical difficulties result from nervous and behavioral abnormalities, which indicate a variety of factors influencing the quality of life.	Educational institutions should be adapted to the intellectual capabilities of premature babies for their adaptation in adult life.	The study of the creative and human sciences in an identical theoretical framework.	Increasing the influence of nursing educators in building curricula for premature infants.

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