Mediators of behavioral problems in 7-year-old children born after 24 to 28 weeks of gestation

We tested the hypothesis that prematurity acts through its association with neuromotor and intellectual functioning to explain behavior problems at sc hool age. Sixty-one extremely preterm (EP) very low birth weight (VLBW) chi ldren (< 29 wk and < 1500 g) born in 1987-1990 and 44 normal birth weight c hildren (NBW) (> 37 wk and > 2500 g) were matched for age, sex, and socioec onomic status (SES). Mediator variables were evaluated at a hospital at 5 y ears and 9 months. Behaviors were evaluated at school at 7 years by peers, teachers, and parents. When compared with NEW children, EP/VLBW children ha d poorer IQ and neuromotor development. At school, EP/VLBW children were ev aluated by peers as more sensitive/ isolated, and by teachers and parents a s more inattentive and hyperactive than NEW. When mediators were introduced , the previously significant relation between prematurity and behavior prob lems disappeared. Hyperactive and inattentive behaviors were explained by a specific working memory factor for the fatter, and by a general intellectu al delay for the former, whereas sensitive/isolated behaviors were best exp lained by neuromotor delays. Inattentive behaviors were also related to fam ily adversity. At school age, extreme prematurity had thus an indirect effe ct on behaviors via specific and nonspecific intellectual and neuromotor de lays.