Biological mechanisms associated with anxiety in very preterm children
Research type
Research Study
Full title
Understanding the biological mechanisms associated with anxiety in very preterm children
IRAS ID
233389
Contact name
Chiara Nosarti
Contact email
Sponsor organisation
King's College London
Duration of Study in the UK
2 years, 9 months, 1 days
Research summary
Research Summary
Thirteen million infants are born preterm annually, and approximately one quarter of survivors go on to experience life long neuropsychiatric problems. It is a public health priority to increase our understanding of the origins of mental illness by explicating neurodevelopmental mechanisms. Furthermore, there is an urgent need for research that can inform on how to intervene to reduce psychiatric risk. This study will address these issues by investigating for the first time the neurodevelopmental mechanisms associated with core components of anxiety following very preterm birth. Secondly, neuroimaging information acquired during the neonatal period will be used to outline predictors of anxiety by identifying early in life those children who are vulnerable to experiencing impairments in emotion-regulation, emotion processing and anxiety sensitivity. Exploring these questions will allow the identification of vulnerable children who could benefit from preventive interventions before any psychiatric problem manifests. Finally, in the immediate future we will translate newly acquired knowledge into developing a novel video game aimed at enhancing children’s socio-emotional competency. We aim to use this information to improve life course outcomes of preterm individuals.
Summary of Results
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.”
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://gbr01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fu2790089.ct.sendgrid.net%2Fls%2Fclick%3Fupn%3DXv3JSvJ-2B3M71ppf7N9agbWxyF2bUhiYZp0NMZfqIOJYNIr0-2BmivBnWoy-2Fi5ZQDPFEbNovKGdp-2BQYZlmVjQClh0dleL5z2cKFD4ken2GMQuoqQs8Z72qQizpGv5-2FT6Z-2BVQkX9Cy4NI4zzPAUn4CqmR-2BoNWrQFMKgugZPqGR7iXqUlnn7xfrQN9McetcxW6hfG27bl_E1aO2-2BZlVOSJJV-2FajQqskegTd6IRomHYTi-2Fbt8SH3YLYtY0n-2FFiDefuhUpQIYrr2yuVaYfZ8Gz4M2xWigCQJUaKRErHLKrCAX9OMM1pyFSVaiiG48x0oiCztTVVBvGcnAYaXE9bcGkAZD-2B5GGuP34BYbCsh7JBiGUWsQnHVza6lJO5gxqX9Biwejmf2se1kCm5s534TjXKaJCAqxPSHl5g-3D-3D&data=05%7C01%7Cstanmore.rec%40hra.nhs.uk%7C70a4cac12ea24a3c902b08dbf2566732%7C8e1f0acad87d4f20939e36243d574267%7C0%7C0%7C638370225154156552%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=EfhVlm4JXDXHDwq1nPukjrH%2FJoyzL%2B6KOhQo82Q5wMY%3D&reserved=0 [Accessed 16 March 2022]2. Public Health Scotland – Maternity and Births in Scottish hospitals 2018/19: https://gbr01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fu2790089.ct.sendgrid.net%2Fls%2Fclick%3Fupn%3DXv3JSvJ-2B3M71ppf7N9agbZhyFQxWgtRCmM0NKt0CNc-2FcvYRb5TRd05HHJIXWwMN1fkJAvz-2FTs5JOXhhjo9rb5PFr40wF0N6wVXv-2F-2FHbTPi4-3DwqxD_E1aO2-2BZlVOSJJV-2FajQqskegTd6IRomHYTi-2Fbt8SH3YLYtY0n-2FFiDefuhUpQIYrr2XmhuRXoyAVwKmDMT17a9fWI06DypU7Uf4u7JL-2FpSRhsOZmwVgNwrwiV6h-2B7mD8aw2thPsV3uEJjGtQTyyDIfDXnlEu1ihvFjJVx3jd0y7viSVK4zVlAu0anUDJd2-2FErb-2BLAoQ8URU0FcMRPcFzWxbw-3D-3D&data=05%7C01%7Cstanmore.rec%40hra.nhs.uk%7C70a4cac12ea24a3c902b08dbf2566732%7C8e1f0acad87d4f20939e36243d574267%7C0%7C0%7C638370225154156552%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=n%2BGK8yJ5r0D8F7IRNMKNpL0gxA7weHFku0G0WVGfoxk%3D&reserved=0 (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://gbr01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fu2790089.ct.sendgrid.net%2Fls%2Fclick%3Fupn%3DXv3JSvJ-2B3M71ppf7N9agbcIg3h9Tr-2BwTqd4Td2RHM-2FK7uSpWgvTcW8BbZV67cq8NAcIoQMgIa30ycEJded0y3To0lBkHXz3NHkr1U59ztKuBEerdBJivi91bqHMkUkkvAXSw_E1aO2-2BZlVOSJJV-2FajQqskegTd6IRomHYTi-2Fbt8SH3YLYtY0n-2FFiDefuhUpQIYrr2A35NGwxzXgsrpfA3lsoZrzLCAs66e-2FFBjfI6r4ul7APet5YGxW8wi5dqOO45PWkEz3kR-2FdrzbJkVQccPy-2FlWpx6ycYQ74EhQqYXxuaAy6RV5EpbDrZkLqHDSoj2EcVrjYWDblWz0vxEBAL-2BCJUKhSw-3D-3D&data=05%7C01%7Cstanmore.rec%40hra.nhs.uk%7C70a4cac12ea24a3c902b08dbf2566732%7C8e1f0acad87d4f20939e36243d574267%7C0%7C0%7C638370225154156552%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=f6lbpU9jBWkvnyZGmd9fTbQ3EssEjSncXV7hjuBu7NI%3D&reserved=0 [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.
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Did you follow your dissemination plan submitted in the IRAS application form (Q A51)?: Yes
If yes, describe or provide URLs to disseminated materials: 10.3390/children9040508
10.1093/braincomms/fcac009
10.1523/ENEURO.0546-20.2021
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London - Stanmore Research Ethics Committee
REC reference
18/LO/0048
Date of REC Opinion
29 Mar 2018
REC opinion
Further Information Favourable Opinion