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What did the project achieve?
“Our findings show that early brain changes in very preterm babies are associated with their social and emotional outcomes later in childhood,” says Professor Chiara Nosarti of King’s College London. “This could lead to new ways to identify the most vulnerable children early in life – and help to inform the development of early support and treatment aimed at preventing and reducing anxiety and emotional problems as they grow up, improving the long-term quality of life for children and their families.”
Estimates suggest that around 8,000 babies are born very prematurely, before 32 weeks of pregnancy, every year in the UK.1-3 Being born very early can result in many challenges for children as they grow up, including an increased risk of anxiety and other mental health problems.4
Professor Nosarti aimed to identify specific patterns of brain development in very preterm children who develop problems with anxiety, controlling their emotions and general mental health as they grow up. Her team has compared information from brain scans taken around the time of birth and in childhood – and behavioural assessments – in 50 children who were born very early and a group of similar-aged children born at full-term.
“We have found that very preterm children had more mental health problems at seven years of age, including higher anxiety and behaviours linked with autism spectrum disorder compared to those who were born at full-term,” says Professor Nosarti. “They also had lower IQ scores – and were less able to control their emotions and inhibit unwanted behaviours.”
The researchers then studied how the children’s brains responded when they were shown faces expressing negative emotions during a brain scan.
“When very preterm children were shown fearful faces, they showed more activation in an area of the brain that plays an important role in the ability to understand and share the feelings of other people compared to children born at full-term,” says Professor Nosarti.
The researchers also looked at whether specific brain changes identified in preterm newborn babies could predict their social and emotional development in childhood. They found that children’s tendency to attribute negative emotions to daily events, which could lead to increased anxiety, were linked with specific brain alterations. Very preterm children had weaker connections within several ‘highways’ of the brain – which allow different regions to communicate with each other – in areas associated with anxiety and emotion processing, as well as learning and memory.
“Our findings increase understanding of some of the biological mechanisms that could explain why many very preterm babies go on to experience mental health problems later in childhood,” says Professor Nosarti. “This will enable doctors and psychologists to better understand how the brain reacts to preterm birth – and will allow new preventative treatments or targeted therapies to be started in a timely and effective way to help the most vulnerable children.”
The team has since been awarded further funding from the Medical Research Council (MRC) to extend this research – which will look at more children and also explore the role of the immune system on changes in the brain and mental health problems.
References
1. Office for National Statistics Birth Characteristics: Table 8: Births by gestational age at birth and ethnicity of live births, 2020 Birth characteristics: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/livebirths/datasets/birthcharacteristicsinenglandandwales [Accessed 16 March 2022]
2. Public Health Scotland – Maternity and Births in Scottish hospitals 2018/19: https://www.isdscotland.org/Health-Topics/Maternity-and-Births/Births/ (Table 7.1) [Accessed 16 March 2022
3. Northern Ireland Statistics and Research Agency – Births, Deaths and Marriages, Registrar General Annual Report 2020 Births: https://www.nisra.gov.uk/publications/registrar-general-annual-report-2020-births [Accessed 16 March 2022]
4. Johnson S et al. Early and long-term outcome of infants born extremely preterm. Archives of Disease in Childhood 2017; 102: 97-102.
This research was completed on
Estimates suggest around 15,500 babies are born very early, before 32 weeks of pregnancy, each year in the UK.1-5 Babies who are born this early are thought to be nearly twice as likely as other babies to have problems with anxiety during adolescence.6 Anxiety can leave children feeling scared or embarrassed, for example, or cause physical symptoms like tummy ache. It can interfere with school, home and social life. Dr Chiara Nosarti, of King’s College London, is developing a way to tell which babies are most likely to have problems with anxiety while they’re growing up, so they can get early support and treatment.
How are children’s lives affected now?
“Being born very early can result in many challenges for children as they grow up, including an increased risk of anxiety and other mental health problems,” says Dr Nosarti.7 “Children may find it hard to relate to other people and to understand emotions, for example, causing significant psychological distress for them and their families.
“If children develop severe anxiety, this can have wide-ranging effects on all aspects of life, including relationships, education and future employment, seriously harming young lives” says Dr Nosarti.
A lot can be done to help stop children from being anxious and to support them if they are showing signs of anxiety. Although babies who were born very early are known to be at increased risk of anxiety, at the moment it’s not possible to tell, before early signs and symptoms start to appear, which of those babies will, and which babies won’t, go on to be affected.
How could this research help?
The researchers aim to develop a way to use brain scans, taken around the time of birth, to predict which babies who are born very early might have problems with anxiety as they grow and develop.
Around 50, seven-year-old children who were born before 32 weeks of pregnancy are taking part in the study, along with another 50 children who were born at full term.
“If we could use brain scans to identify those premature babies who are most at risk of anxiety in the future, then monitoring and early treatment might prevent, or reduce, symptoms, and spare both the babies and their families from a great deal of distress,” says Dr Nosarti.
In the future, the researchers plan to use their new understanding of the links between anxiety and changes in the brain to design a new video game, with the aim of helping vulnerable children to develop their social skills and gain better control of their emotions.
Funded by a generous donation from Dangoor Education.
References
1. WHO Preterm Birth Fact Sheet http://www.who.int/mediacentre/factsheets/fs363/en/Accessed 06 September 2017
2. NICE guidance doc for Preterm labour and birth 2013.
3. Office for National Statistics. Statistical bulletin: Births in England and Wales: 2016. Live births, stillbirths, and the intensity of childbearing measured by the total fertility rate. https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/livebirths/bulletins/birthsummarytablesenglandandwales/2016 Website accessed 6 Sep 2017.
4. National Records of Scotland: 2016 Births, Deaths and Other Vital Events – Preliminary Annual Figures. Table P2. https://www.nrscotland.gov.uk/statistics-and-data/statistics/statistics-by-theme/vital-events/general-publications/births-deaths-and-other-vital-events-preliminary-annual-figures/2016 Website accessed 6 Sep 2017.
5. Northern Ireland Statistics and Research Agency. Births. Monthly births. https://www.nisra.gov.uk/publications/monthly-births Website accessed 6 Sep 2017.
6. Sømhovd MJ et al. Anxiety in adolescents born preterm or with very low birthweight: a meta-analysis of case-control studies. Dev Med Child Neurol 2012; 54: 988-94.
7. Johnson S et al. Early and long-term outcome of infants born extremely preterm. Archives of Disease in Childhood 2017; 102: 97-102.
| Project Leader | Dr Chiara Nosarti PhD |
| Project Team | Professor J Serena Counsell PhDProfessor Francesca GE Happé PhD |
| Project Location | Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London |
| Project Location Other | Centre for the Developing Brain, Department of Perinatal Imaging and Health, Faculty of Life Sciences and Medicine, King’s College LondonMRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London |
| Project duration | 3 years |
| Date awarded | 24 July 2017 |
| Project start date | 1 March 2018 |
| Project end date | 30 August 2021 |
| Grant amount | £185,999 |
| Grant code | GN2606 |
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