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 Appendix X. 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.