The impact of preterm birth on adaptive behaviour and participation in childhood occupation

Abstract

Background: Premature infants are at increased risk of developing motor, cognitive and behavioural impairments compared with infants born at term. Outcome studies have tended to focus their assessments predominately on 'components‘ of skills without relating these deficits to the impact they have on a child‘s everyday life i.e. 'childhood occupations‘.

Objective: To compare the adaptive functioning and participation in everyday life of preterm VLBW infants and their full term, average birth weight peers.

Methods: 44 former premature infants between 6 months – 5 years 6 months, who did not have a physical or intellectual disability, were compared with 51 term born infants, matched for age and sex. Study infants had an average gestation of 29 weeks and birth weight of 1145 grams. Adaptive functioning and participation in everyday life were assessed using established standardised questionnaires: the Adaptive Behavior Assessment Scale-II (ABAS-II) and the Assessment of Preschool Children‘s Participation (APCP).

Results: Premature infants had significantly lower mean scores in overall adaptive behaviour compared to term control infants, regardless of whether chronological age (p<0.001; difference=13.6, 95% CI=[8.2, 19.1]) or corrected age (p=0.013; difference=6.6, 95% CI=[1.4, 11.8]) was used. In addition, premature infants had significantly lower mean scores in conceptual, social and practical adaptive skills compared to full term peers when their chronological age was used and in practical and social adaptive skills but not conceptual skills when their age was corrected for prematurity. There was no difference between groups‘ intensity (Play p=.773; Skill Development p=.661; Active Physical Recreation p=.334; Social p=.528) or diversity of participation (p=0.860).

Conclusion: Premature infants had significantly lower scores in overall adaptive functioning than their full term peers. These weaknesses appeared to be present despite participation in the same childhood activities. These findings suggest a measurable effect of preterm birth alone on childhood occupations that merits further investigation.