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Nearly all data obtained is retrospective and with disparate results&#44; although most indicate a greater incidence of behavioural and cognitive disorders and learning difficulties when compared to healthy term newborns&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">5&#8211;7</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">A large percentage of these children are not sufficiently evaluated after birth&#44; and it is not known whether they present injuries associated with prematurity or secondary to neonatal morbidity&#46; LPs are followed-up by their primary care paediatricians or family doctors&#44; and unlike extremely premature newborns&#44; there are no follow-up programmes specifically for this population&#46; In the USA&#44; 5&#8211;15&#37; of children present developmental deficits and&#44; in the absence of systematic evaluation tests&#44; only 30&#37; are diagnosed before school age&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">8</span></a> For this reason&#44; the application of standardised screening scales at particular ages or due to risk factors is recommended&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">9</span></a> Bayley&#39;s scale<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">10</span></a> is considered the standard for full measurement of child development&#44; but it takes time and requires highly specialised personnel&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Questionnaires for parents and caregivers were prepared to overcome these difficulties&#46; These instruments have been shown to be valid and reliable&#46; The most widely used is the Ages and Stages Questionnaires<span class="elsevierStyleSup">&#174;</span> &#40;ASQ&#41;&#44; developed by the University of Oregon&#44; later updated and validated in various countries&#44;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">11</span></a> translated into Spanish<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">12</span></a> and validated in Chile<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">13&#44;14</span></a> and Spain&#44; in Galicia&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">15</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Recognising the LP as a &#8220;population at risk&#8221;&#44; would provide an easily administered and reliable tool to screen for development deficits&#44; giving greater insight into this population and eliminating delays in prognosis and therapy&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The objective of this study was to evaluate&#44; with a questionnaire answered by parents&#44; the psychomotor development at 48 months of age of LPs born in our centre in 2009&#44; and to compare them with healthy term &#40;HT&#41; newborns&#44; to verify the hypothesis that LPs have twice the risk of psychomotor development difficulties than healthy term newborns&#46;<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">16&#44;17</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Population and method</span><p id="par0040" class="elsevierStylePara elsevierViewall">Retrospective cohort study&#46; LPs born in the private hospital of a health insurance company with a IIIB care level neonatal unit were enrolled&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">18</span></a> Two groups were established&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8211;</span><p id="par0045" class="elsevierStylePara elsevierViewall">Study group&#58; this included premature newborns with 34<span class="elsevierStyleSup">&#43;0</span> to 36<span class="elsevierStyleSup">&#43;6</span> weeks of gestation&#44; born in the hospital in 2009&#44; and who reached the age of 48 months during 2013&#46; Those with known malformation syndromes&#44; genetic or metabolic diseases were excluded&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8211;</span><p id="par0050" class="elsevierStylePara elsevierViewall">Control group&#58; this included single gestation HT newborns&#44; between 38<span class="elsevierStyleSup">&#43;0</span> and 41<span class="elsevierStyleSup">&#43;6</span> weeks of age&#44; born in the same period as the study group&#44; and apparently healthy&#46; Those admitted during the neonatal period and with malformation syndromes were excluded&#46; A HT newborn was chosen for each LP included in the study&#44; matched by date of birth&#46;</p></li></ul></p><p id="par0055" class="elsevierStylePara elsevierViewall">The total number of LPs born during this time period was 155 &#40;8&#46;7&#37; of live births&#41;&#46; Their parents were contacted by telephone to explain the aim of the study and to request their participation&#46; Of this total&#44; 90 &#40;57&#37;&#41; accepted&#44; and the remainder either did not accept or were unreachable&#46; The absence of significant bias between the studied LP and the excluded populations was analysed&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The control group comprised 90 HT newborns&#46; All parents contacted by telephone agreed to take part in the study&#46; One of them was excluded after a 42-week gestation was confirmed&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">In both groups&#44; the variables of weight at birth&#44; gestational age measured according to obstetric data such as the date of last period and ultrasound control&#44; gender&#44; presence of twins&#44; type of delivery&#44; either vaginal or caesarean&#44; and admission to the Neonatal Unit were recorded&#46; In the latter case&#44; the following parameters were recorded&#58; respiratory pathology&#44; hyperbilirubinaemia which required phototherapy&#44; apnoea&#44; hypoglycaemia &#40;&#60;40<span class="elsevierStyleHsp" style=""></span>mg&#47;dl in the first 48<span class="elsevierStyleHsp" style=""></span>h&#41;&#44; requirement of respiratory assistance &#40;mechanical ventilation or CPAP&#41; or surgery&#46; Information about breastfeeding after 1 month of postnatal life&#44; maternal age at the time of evaluation&#44; academic level of the parents&#44; single-parent family habits&#44; and postnatal readmissions within the first year of life was gathered&#46; The socio-economic level was deemed homogeneous &#40;mid-high&#41;&#44; and all parents were able to afford private health care insurance&#46; The age at which the questionnaire was administered was noted&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">The evaluation of psychomotor development was conducted by means of a questionnaire&#44; ASQ-3 in Spanish&#44;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">12</span></a> to be completed by the parents of the children at 48 months&#46; According to the manual&#44; it could be validly completed between 45 and 50 months and 30 days&#44; as close as possible to 48 months&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Parents were offered the possibility to complete the questionnaire via email or during a home visit by a non-health professional who simply delivered the document and gave advice when needed&#46; As for HT newborns&#44; if parents preferred it&#44; they could complete the form in the paediatrician&#39;s office or via email&#46; They were given written information about the study&#44; an evaluation questionnaire and an informed consent document&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Once the documents were collected and the questionnaire obtained&#44; the parents were informed of the results via email or&#44; in the case of detecting anomalies&#44; they were scheduled for an office visit with the aim of providing advice on how to address the evolution of the child&#44; following a consultation with their attending paediatrician&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">The project was approved by the Ethics and Teaching Commission of the Hospital&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Evaluation instrument&#58; the evaluation of psychomotor development was made by means of a questionnaire&#44; ASQ-3 in Spanish<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">12</span></a> that is easy to understand and quick to complete&#46; There are 21 versions&#44; adequate for each age&#44; from 2 to 60 months&#46; Each includes the five domains of development&#58; communication&#44; fine and gross motor skills&#44; problem resolution&#44; and sociability&#46; In each section&#44; six questions are raised about child performance&#44; the answers to which were&#58; &#8220;yes&#44; he usually does that &#40;10 points&#41;&#44;&#8221; &#8220;only sometimes &#40;5 points&#41;&#44;&#8221; or &#8220;not yet&#8221; &#40;0 points&#41;&#46; The result is obtained by adding each domain and the global score&#46; Furthermore&#44; there are nine questions for the parents to answer directly and subjectively about some development and behavioural traits of their child&#46; The total and partial scores are compared to the cut-off points determined by the ROC method&#44; classifying the result as optimal&#44; intermediate or low for the age&#44; the latter being the average-2 SD&#46; If at least one domain or area evaluated falls in the negative result area&#44; more complex diagnostic tests are advisable with the aim of confirming this and starting adequate therapy&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">For this study&#44; the version of ASQ-3 at 48 months was used&#44; attempting to have it completed as closely as possible to 48 months&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Statistical analysis</span><p id="par0100" class="elsevierStylePara elsevierViewall">To calculate the sample size&#44; a power of 80&#37;&#44; a significance of 5&#37;&#44; and an estimated relative risk of 2&#46;2<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">16&#44;17</span></a> were applied&#44; assuming the risk rate among HT newborns to be 15&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">9</span></a> A sample size of 89 children per group was obtained&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Continuous variables were described as mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#44; and compared by means of the Student&#39;s <span class="elsevierStyleItalic">t</span> test for independent samples&#46; Categorical variables were described as frequencies and proportions&#44; and compared by means of the chi-square independence test&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">ROC analysis was performed to determine the ASQ-3 cut-off value for risk of psychomotor development deficit &#40;PDD&#41;&#46; This point was set at 251&#44; achieving a sensitivity of over 85&#46;5&#37;&#46; Using the Kolmogorov&#8211;Smirnov test&#44; it was determined that the distribution of probabilities of the total score was not significantly different between LP and HT for values above the cut-off point&#46; This cut-off point was compared to the theoretical cohort point&#44; a result obtained by subtracting 2SD from the average value of the standard sample &#40;HT&#41;&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Two models were generated by means of step-wise logistic regression with a binary &#40;risk&#47;no risk&#41; response with a retention probability of 0&#46;5&#46; The first model included the biodemographic&#47;perinatal risk factors &#40;sex&#44; gestational age&#44; age at completion of ASQ-3&#44; age of mother&#44; education of mother&#44; single-parent habits&#44; caesarean delivery&#44; breastfeeding&#41;&#44; and the second model included the clinical factors related to perinatal morbidity &#40;neonatal admission&#44; respiratory distress&#44; mechanical and&#47;or CPAP ventilation&#44; apnoea&#44; sepsis&#44; hypoglycaemia&#44; hyperbilirubinaemia&#44; surgery&#44; postnatal readmission&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Results</span><p id="par0120" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the characteristics of the study population&#46; Notably&#44; there is no difference between evaluated LPs and those who did not participate&#46; Differences observed between LP and HT in weight&#44; gestational age&#44; presence of twins&#44; caesarean rate&#44; and admission to neonatology are as expected&#44; considering the HT selection criteria&#46; There were no differences in sex&#44; single-parent habits and age at completion of the ASQ-3&#46; There were differences regarding university education and breastfeeding rate&#44; which were higher in the control group&#46; Maternal age in the LP group was 1 year older compared to the HT group&#44; and postnatal readmission during the first year of life was significantly higher among LPs&#46; The age at the time of the test was 47&#8211;50 months&#44; with an average of 48&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44; with no differences between groups&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">The average scores in each of the domains and the global performance of the ASQ-3 did not show differences between LP and HT &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0130" class="elsevierStylePara elsevierViewall">When plotting density of probabilities for the total score of ASQ-3&#44; it was noted that both groups have an equivalent distribution starting at a total score of 251 points&#44; and that below this point there are more LPs with low scores &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; This cut-off point was consistent with the 2 SD-average of the HT newborn sample of reference&#46; The ROC analysis showed a sensitivity of &#62;85&#46;5&#37; for this point&#46; The Kolmogorov&#8211;Smirnov test did not show evidence of a different distribution of probabilities between groups for scores over the cut-off point &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;68&#41;&#46; Based on this analysis&#44; a score equal to or lower than 250 was deemed a PDD risk&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">Analysing the groups based on the cut-off points&#44; 19 children appear to have PDD risk&#44; of which 15 were LPs &#40;16&#46;67&#37;&#41; and 4 were HTs &#40;4&#46;5&#37;&#41;&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">In the logistic regression model&#44; with explanatory biodemographic&#47;perinatal variables&#44; late prematurity &#40;OR 3&#46;68&#44; CI 95&#37;&#44; 1&#46;14&#8211;11&#46;81&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;03&#41; and the absence of breastfeeding &#40;OR 3&#46;3&#44; CI 95&#37;&#44; 1&#46;22&#8211;9&#46;3&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;02&#41; were significant&#46; In the model with explanatory clinical variables related to perinatal morbidity&#44; only prematurity was significant &#40;OR 5&#46;06&#44; CI 95&#37;&#44; 1&#46;6&#8211;15&#46;98&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;006&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Discussion</span><p id="par0145" class="elsevierStylePara elsevierViewall">A comparison of the global ASQ-3 score between LPs and HTs does not seem to support the initial working hypothesis&#46; The same may be said of each of the domains explored by the questionnaire&#44; in which no differences may be noted between groups&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">However&#44; considering the global score distribution in this sample&#44; differences do emerge&#44; so that LPs have higher PDD risk than HTs&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">These results encourage an in-depth analysis about long-term clinical significance&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">An objection might be based on the high percentage of non-participating LPs&#46; Difficulties contacting them hindered their involvement&#46; This was not the case with matched HTs since&#44; with a higher number of candidates&#44; those who were contacted and who met the inclusion criteria were enrolled&#46; It would be desirable to have a higher number of LPs&#44; but reaching the minimum number required by the sample calculation and the absence of differences in gestational age&#44; weight&#44; gender and neonatal morbidity between both groups suggest absence of bias in this respect&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Another aspect which should be considered is the characteristics of the population&#44; with a mid-high socio-economic level and a high university education of parents&#44; not comparable&#44; possibly&#44; with other studies focusing on a different social and economic population&#46; The influence of the socio-economic level is increasingly evident&#44; both in terms of neonatal morbidity as an independent factor<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">19</span></a> and in long term neurological development&#44; with PDD risk increasing when both levels are low&#46;<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">20&#44;21</span></a> The results obtained contrasted with ASQ-3 scores of children with PDD in Chile at 8&#44; 18 and 30 months&#46;<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">14&#44;22</span></a></p><p id="par0170" class="elsevierStylePara elsevierViewall">The completion of this study at 48 months is not random&#44; since it may be considered the last step for the detection of deficits that can benefit from therapy&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">23</span></a> The main difficulty in the application of this questionnaire resides in the absence of validation in our country&#46; It has been conducted in Spanish among younger children in Santiago de Chile<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">13&#44;14</span></a> and in Galicia&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">15</span></a> It is considered an excellent method for screening developmental difficulties in the USA&#44; the Netherlands&#44; Norway&#44; Canada&#44; France&#44; Korea&#44; Turkey&#44; India&#44; Iran and Brazil&#59; in these countries&#44; specific tests have been validated for each age&#44; with sensitivity and specificity of around 88&#37; and 82&#46;5&#37;&#44; respectively&#46;<a class="elsevierStyleCrossRefs" href="#bib0320"><span class="elsevierStyleSup">24&#44;25</span></a></p><p id="par0175" class="elsevierStylePara elsevierViewall">Considering deficits per domain decreases sensitivity and increases the specificity of the test&#44; and therefore some authors have chosen to use global scoring as an evaluation of psychomotor development&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">26</span></a></p><p id="par0180" class="elsevierStylePara elsevierViewall">Considering the characteristics of the study population&#44; with a highly selective control group as a reference&#44; the cut-off point is determined based on statistical criteria&#44; thus resulting in 251 points&#46; It was also observed that a greater number of children with PDD were found in the LP group compared to the HT control group &#40;16&#46;67&#37; vs&#46; 4&#46;5&#37;&#44; respectively&#41;&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">When the regression method was applied to demographic and perinatal variables&#44; only late prematurity and the absence of breastfeeding past 1 month of life were associated with PDD&#59; when it was applied to neonatal morbidity variables&#44; only gestational age was significant&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">For Schonhaut et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">22</span></a> in prematures with 32&#8211;36 weeks of gestational age&#44; gender&#44; restricted intrauterine growth &#40;RIG&#41;&#44; presence of twins&#44; and admission to neonatal intensive care &#40;ICU&#41; are factors probably associated with a higher risk of PDD&#44; while for Kerstjens et al&#46;&#44; these factors are multiple gestations&#44; RIG&#44; children of obese mothers&#44; and hypoglycaemia&#46;<a class="elsevierStyleCrossRefs" href="#bib0335"><span class="elsevierStyleSup">27&#44;28</span></a> None of these were listed as significant in our study population&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">Admission to the Neonatal Unit is associated with various hospital protocols&#46; It would probably be more accurate as a variable for admission into neonatal ICU&#44;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">29</span></a> although not everyone agrees that this is associated with poor neurological prognosis&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">30</span></a></p><p id="par0200" class="elsevierStylePara elsevierViewall">The significance of absence of breastfeeding in the study population is notable&#46; Breastfeeding is known to be a beneficial stimulant for brain development of LPs&#44; particularly during the myelination stage&#46;<a class="elsevierStyleCrossRefs" href="#bib0355"><span class="elsevierStyleSup">31&#44;32</span></a> Furthermore&#44; the difficulty of achieving successful breastfeeding among these children is well known&#44; due to neurological immaturity&#44; difficulties with suction and co-ordination&#44; difficulties with maternal lactogenesis&#44; and due to poor or no health training during the immediate neonatal period&#44; leading to hospital readmissions due to difficulties in feeding&#44; malnutrition&#44; hyperbilirubinaemia and hypoglycaemia&#46;<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">33</span></a></p><p id="par0205" class="elsevierStylePara elsevierViewall">Late prematurity and neonatal and postnatal morbidity appear to be significantly associated with PDD risk&#44;<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">19&#44;34&#44;35</span></a> this being greater the lower the gestational age&#46; However&#44; some studies have found no differences in neurological development of LPs at 12 months&#44;<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">36</span></a> and no conduct and learning issues during school age&#46;<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">37</span></a> Others&#44; on the contrary&#44; detect poorer school performance between 4 and 7 years among LPs&#46;<a class="elsevierStyleCrossRefs" href="#bib0390"><span class="elsevierStyleSup">38&#44;39</span></a></p><p id="par0210" class="elsevierStylePara elsevierViewall">If we accept the risk of this population presenting behavioural disorders&#44; we must be aware of the importance of having a useful&#44; easy and reliable tool for the early detection of PDD risk&#46; However&#44; the problem may reside in the adaptation and validation of this questionnaire to each population&#44; with the necessary adjustments in the cut-off points that define the standards&#46; The need to achieve maximum sensitivity is obvious&#44; but it is important to avoid an excessive number of false positives that would cause an emotional burden in families and a care burden for healthcare services&#46;<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">40</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conclusion</span><p id="par0215" class="elsevierStylePara elsevierViewall">The follow-up study shows&#44; in consideration of the global ASQ-3 score&#44; a higher prevalence of PDD risk among LPs compared to HT newborns according to the criteria used&#46; The consistency of these results should be checked to confirm their clinical significance&#46; The characteristics of the population&#44; as well as the absence of method validation in our country&#44; are limitations to consider&#46; In spite of wide consensus&#44; obtained through multiple published studies&#44; that LPs are at risk of presenting developmental anomalies&#44; even as adults&#44; it should be further investigated to determine if this statement corresponds to all the population or only to those with certain key perinatal development variables&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflict of interests</span><p id="par0220" class="elsevierStylePara elsevierViewall">The authors state there is no conflict of interest&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Lack of specific monitoring protocols hinders understanding of the impact of late prematurity on delayed psychomotor development&#46; The objective of this study is to evaluate this development at 48 months and compare it with infants born at term&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Population and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A retrospective cohort study was conducted on 90 late preterm &#40;LP&#41; and 89 term &#40;HT&#41; healthy children at 48 months&#44; assessed by the Ages &#38; Stages Questionnaires<span class="elsevierStyleSup">&#174;</span> &#40;ASQ-3&#41;&#46; Continuous variables were analysed using the Student&#39;s <span class="elsevierStyleItalic">t</span> test for independent samples and described in terms of mean and standard deviation&#46; The categorical variables were analysed using the <span class="elsevierStyleBold">chi-square test of independence</span> and described in terms of frequency and proportion&#46; ROC analysis was performed to determine the ASQ-3 cut-off value for risk of development deficit&#46; A step-wise logistic regression model identified the associated risk factors&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The mean scores for each domain and overall ASQ-3 score showed no differences between groups&#46; However&#44; when analyzing the probability density for the ASQ-3 total score of &#8804;251 points&#44; 15 LP &#40;16&#46;6&#37;&#41; and 4 AT &#40;4&#46;5&#37;&#41; showed risk of psychomotor deficits&#44; and late prematurity and lack of breastfeeding were significantly associated factors&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">There is an increased prevalence of risk of development deficit in LP infants&#44; which justifies considering this population at risk and establishing effective monitoring programmes&#46; It should be further investigated whether this risk corresponds to the entire population&#44; or if biological factors or perinatal history can increase vulnerability&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Population and methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusions"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La ausencia de protocolos espec&#237;ficos de seguimiento dificulta el conocimiento de la repercusi&#243;n de la prematuridad tard&#237;a en el desarrollo psicomotor&#46; El objetivo es evaluarlo a los 4 a&#241;os y compararlo con los nacidos a t&#233;rmino &#40;AT&#41;&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Poblaci&#243;n y m&#233;todo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio de cohortes retrospectivo de 90 prematuros tard&#237;os &#40;PT&#41; y 89 AT sanos&#44; a los 48 meses&#44; evaluados mediante el Ages &#38; Stages Questionnaires<span class="elsevierStyleSup">&#174;</span> &#40;ASQ-3&#41;&#46; Las variables continuas se describen mediante media<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DE comparadas con el test de la t de Student para muestras independientes&#59; las variables categ&#243;ricas&#44; mediante frecuencias y proporciones&#44; comparadas con el test de independencia de la chi al cuadrado&#46; Se determin&#243; un punto de corte para la puntuaci&#243;n total del ASQ-3 capaz de discriminar el riesgo de d&#233;ficit del desarrollo mediante un an&#225;lisis ROC&#46; Una selecci&#243;n step-wise para el modelo de regresi&#243;n log&#237;stica determin&#243; los factores de riesgo asociados&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Las puntuaciones medias de cada dominio y de la puntuaci&#243;n global del ASQ-3 no mostraron diferencias entre ambos grupos&#46; Sin embargo&#44; al analizar la densidad de probabilidades para la puntuaci&#243;n global del ASQ-3<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>251 puntos&#44; 15 PT &#40;16&#44;6&#37;&#41; y 4 AT &#40;4&#44;5&#37;&#41; mostraban riesgo de d&#233;ficit psicomotor&#44; y la prematuridad tard&#237;a y la ausencia de lactancia materna resultaron factores asociados significativamente&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Hubo una mayor prevalencia de riesgo de d&#233;ficit en el desarrollo en los PT&#44; lo que justifica considerar esta poblaci&#243;n de riesgo y establecer programas de seguimiento eficientes&#46; Debe seguirse investigando si este riesgo corresponde a toda la poblaci&#243;n o si existen factores biol&#243;gicos o antecedentes perinatales que los hacen m&#225;s vulnerables&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Introducci&#243;n"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Poblaci&#243;n y m&#233;todo"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Demestre X&#44; Schonhaut L&#44; Morillas J&#44; Mart&#237;nez-Nadal S&#44; Vila C&#44; Raspall F&#44; et al&#46; Riesgo de d&#233;ficits en el desarrollo en los prematuros tard&#237;os&#58; evaluaci&#243;n a los 48 meses mediante el Ages &#38; Stages Questionnaires<span class="elsevierStyleSup">&#174;</span>&#46; An Pediatr &#40;Barc&#41;&#46; 2016&#59;84&#58;39&#8211;45&#46;</p>"
      ]
    ]
    "multimedia" => array:4 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1171
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Probability density total ASQ-3 scores according to gestational age&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">ASQ-3&#44; Ages &#38; Stages Questionnaires&#59; SD&#44; standard deviation&#59; NS&#44; non-significant&#59; LP&#44; late premature&#59; NU&#44; Neonatal Unit&#59; GA&#44; gestational age&#46;</p>"
          "tablatextoimagen" => array:1 [
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Non-included LP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Study LP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Healthy term&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">N</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">89&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Weight&#44; average<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD &#40;g&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2505<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>351&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2464<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>437&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3337&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>447&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">GA&#44; average<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD &#40;weeks&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">39&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Male &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">33 &#40;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">55 &#40;61&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">49 &#40;55&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Twin &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30 &#40;45&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">34 &#40;38&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Caesarean &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">44 &#40;66&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">57 &#40;63&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">39 &#40;43&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">NU admission &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">33 &#40;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">54 &#40;60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Maternal university education&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">69 &#40;76&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;0485&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">76 &#40;85&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Single parent &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;3&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;2&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Age of the mother&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">39&#46;24<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">38&#46;02<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Breastfeeding &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">54 &#40;60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">65 &#40;73&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">ASQ-3 age&#44; average<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD &#40;months&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">48&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">48&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Postnatal readmission &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12 &#40;13&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 &#40;5&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Sample description&#46;</p>"
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                  "contribucion" => array:1 [
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                        0 => array:2 [
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                  ]
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                    0 => array:2 [
                      "titulo" => "Long-term outcomes of moderately preterm&#44; late preterm and early term infants"
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                      "doi" => "10.1016/j.clp.2013.07.006"
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                0 => array:2 [
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                      "titulo" => "The National Center on Birth Defects and Developmental Disabilities&#58; past&#44; present and future"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
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                0 => array:2 [
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                      "titulo" => "Identifying infants and young children with developmental disorders in the medical home&#58; an algorithm for developmental surveillance and screening"
                      "autores" => array:1 [
                        0 => array:2 [
                          "colaboracion" => "American Academy of Pediatrics&#44; Council on Children With Disabilities&#44; Section on Developmental Behavioral Pediatrics&#44; Bright Futures Steering Committee&#44; Medical Home Initiatives For Children With Special Needs Project Advisory Committee"
                          "etal" => false
                        ]
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                    0 => array:2 [
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Bayley scales of infant and toddler development&#44; third edition &#40;Bayley-III&#41;"
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                        0 => array:2 [
                          "etal" => false
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                            0 => "N&#46; Bayley"
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Original Article
Development deficit risks in the late premature newborn: Evaluation at 48 months using the Ages & Stages Questionnaires®
Riesgo de déficits en el desarrollo en los prematuros tardíos: evaluación a los 48 meses mediante el Ages & Stages Questionnaires®
X. Demestrea,
Corresponding author
6813xdg@comb.cat

Corresponding author.
, L. Schonhautb, J. Morillasc, S. Martínez-Nadala, C. Vilaa, F. Raspalla, P. Salaa
a Servicio de Pediatría-Neonatología, SCIAS, Hospital de Barcelona, Barcelona, Spain
b Clínica Alemana, Facultad de Medicina, Universidad del Desarrollo, Santiago de Chile, Chile
c Servicio de Urgencias, SCIAS, Hospital de Barcelona, Barcelona, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">In 2005&#44; the vulnerability of the late preterm newborn &#40;LP&#41;&#44; defined as those born between 34<span class="elsevierStyleSup">&#43;0</span> and 36<span class="elsevierStyleSup">&#43;6</span> weeks of gestation replaced the former term &#8220;near term&#8221; that assigned a lower risk assessment to that population&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">There are numerous publications showing greater neonatal morbidity and mortality of LPs when compared to healthy term newborns&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">2&#8211;4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The absence of specialised follow-up programmes has made it difficult to arrive at more definitive conclusions about neurological evolution in the short and medium term&#46; Nearly all data obtained is retrospective and with disparate results&#44; although most indicate a greater incidence of behavioural and cognitive disorders and learning difficulties when compared to healthy term newborns&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">5&#8211;7</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">A large percentage of these children are not sufficiently evaluated after birth&#44; and it is not known whether they present injuries associated with prematurity or secondary to neonatal morbidity&#46; LPs are followed-up by their primary care paediatricians or family doctors&#44; and unlike extremely premature newborns&#44; there are no follow-up programmes specifically for this population&#46; In the USA&#44; 5&#8211;15&#37; of children present developmental deficits and&#44; in the absence of systematic evaluation tests&#44; only 30&#37; are diagnosed before school age&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">8</span></a> For this reason&#44; the application of standardised screening scales at particular ages or due to risk factors is recommended&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">9</span></a> Bayley&#39;s scale<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">10</span></a> is considered the standard for full measurement of child development&#44; but it takes time and requires highly specialised personnel&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Questionnaires for parents and caregivers were prepared to overcome these difficulties&#46; These instruments have been shown to be valid and reliable&#46; The most widely used is the Ages and Stages Questionnaires<span class="elsevierStyleSup">&#174;</span> &#40;ASQ&#41;&#44; developed by the University of Oregon&#44; later updated and validated in various countries&#44;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">11</span></a> translated into Spanish<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">12</span></a> and validated in Chile<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">13&#44;14</span></a> and Spain&#44; in Galicia&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">15</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Recognising the LP as a &#8220;population at risk&#8221;&#44; would provide an easily administered and reliable tool to screen for development deficits&#44; giving greater insight into this population and eliminating delays in prognosis and therapy&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The objective of this study was to evaluate&#44; with a questionnaire answered by parents&#44; the psychomotor development at 48 months of age of LPs born in our centre in 2009&#44; and to compare them with healthy term &#40;HT&#41; newborns&#44; to verify the hypothesis that LPs have twice the risk of psychomotor development difficulties than healthy term newborns&#46;<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">16&#44;17</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Population and method</span><p id="par0040" class="elsevierStylePara elsevierViewall">Retrospective cohort study&#46; 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between 38<span class="elsevierStyleSup">&#43;0</span> and 41<span class="elsevierStyleSup">&#43;6</span> weeks of age&#44; born in the same period as the study group&#44; and apparently healthy&#46; Those admitted during the neonatal period and with malformation syndromes were excluded&#46; A HT newborn was chosen for each LP included in the study&#44; matched by date of birth&#46;</p></li></ul></p><p id="par0055" class="elsevierStylePara elsevierViewall">The total number of LPs born during this time period was 155 &#40;8&#46;7&#37; of live births&#41;&#46; Their parents were contacted by telephone to explain the aim of the study and to request their participation&#46; Of this total&#44; 90 &#40;57&#37;&#41; accepted&#44; and the remainder either did not accept or were unreachable&#46; The absence of significant bias between the studied LP and the excluded populations was analysed&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The control group comprised 90 HT newborns&#46; 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maternal age at the time of evaluation&#44; academic level of the parents&#44; single-parent family habits&#44; and postnatal readmissions within the first year of life was gathered&#46; The socio-economic level was deemed homogeneous &#40;mid-high&#41;&#44; and all parents were able to afford private health care insurance&#46; The age at which the questionnaire was administered was noted&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">The evaluation of psychomotor development was conducted by means of a questionnaire&#44; ASQ-3 in Spanish&#44;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">12</span></a> to be completed by the parents of the children at 48 months&#46; According to the manual&#44; it could be validly completed between 45 and 50 months and 30 days&#44; as close as possible to 48 months&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Parents were offered the possibility to complete the questionnaire via email or during a home visit by a non-health professional who simply delivered the document and gave advice when needed&#46; As for HT newborns&#44; if parents preferred it&#44; they could complete the form in the paediatrician&#39;s office or via email&#46; They were given written information about the study&#44; an evaluation questionnaire and an informed consent document&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Once the documents were collected and the questionnaire obtained&#44; the parents were informed of the results via email or&#44; in the case of detecting anomalies&#44; they were scheduled for an office visit with the aim of providing advice on how to address the evolution of the child&#44; following a consultation with their attending paediatrician&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">The project was approved by the Ethics and Teaching Commission of the Hospital&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Evaluation instrument&#58; the evaluation of psychomotor development was made by means of a questionnaire&#44; ASQ-3 in Spanish<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">12</span></a> that is easy to understand and quick to complete&#46; There are 21 versions&#44; adequate for each age&#44; from 2 to 60 months&#46; Each includes the five domains of development&#58; communication&#44; fine and gross motor skills&#44; problem resolution&#44; and sociability&#46; In each section&#44; six questions are raised about child performance&#44; the answers to which were&#58; &#8220;yes&#44; he usually does that &#40;10 points&#41;&#44;&#8221; &#8220;only sometimes &#40;5 points&#41;&#44;&#8221; or &#8220;not yet&#8221; &#40;0 points&#41;&#46; The result is obtained by adding each domain and the global score&#46; Furthermore&#44; there are nine questions for the parents to answer directly and subjectively about some development and behavioural traits of their child&#46; The total and partial scores are compared to the cut-off points determined by the ROC method&#44; classifying the result as optimal&#44; intermediate or low for the age&#44; the latter being the average-2 SD&#46; If at least one domain or area evaluated falls in the negative result area&#44; more complex diagnostic tests are advisable with the aim of confirming this and starting adequate therapy&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">For this study&#44; the version of ASQ-3 at 48 months was used&#44; attempting to have it completed as closely as possible to 48 months&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Statistical analysis</span><p id="par0100" class="elsevierStylePara elsevierViewall">To calculate the sample size&#44; a power of 80&#37;&#44; a significance of 5&#37;&#44; and an estimated relative risk of 2&#46;2<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">16&#44;17</span></a> were applied&#44; assuming the risk rate among HT newborns to be 15&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">9</span></a> A sample size of 89 children per group was obtained&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Continuous variables were described as mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#44; and compared by means of the Student&#39;s <span class="elsevierStyleItalic">t</span> test for independent samples&#46; Categorical variables were described as frequencies and proportions&#44; and compared by means of the chi-square independence test&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">ROC analysis was performed to determine the ASQ-3 cut-off value for risk of psychomotor development deficit &#40;PDD&#41;&#46; This point was set at 251&#44; achieving a sensitivity of over 85&#46;5&#37;&#46; Using the Kolmogorov&#8211;Smirnov test&#44; it was determined that the distribution of probabilities of the total score was not significantly different between LP and HT for values above the cut-off point&#46; This cut-off point was compared to the theoretical cohort point&#44; a result obtained by subtracting 2SD from the average value of the standard sample &#40;HT&#41;&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Two models were generated by means of step-wise logistic regression with a binary &#40;risk&#47;no risk&#41; response with a retention probability of 0&#46;5&#46; The first model included the biodemographic&#47;perinatal risk factors &#40;sex&#44; gestational age&#44; age at completion of ASQ-3&#44; age of mother&#44; education of mother&#44; single-parent habits&#44; caesarean delivery&#44; breastfeeding&#41;&#44; and the second model included the clinical factors related to perinatal morbidity &#40;neonatal admission&#44; respiratory distress&#44; mechanical and&#47;or CPAP ventilation&#44; apnoea&#44; sepsis&#44; hypoglycaemia&#44; hyperbilirubinaemia&#44; surgery&#44; postnatal readmission&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Results</span><p id="par0120" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the characteristics of the study population&#46; Notably&#44; there is no difference between evaluated LPs and those who did not participate&#46; Differences observed between LP and HT in weight&#44; gestational age&#44; presence of twins&#44; caesarean rate&#44; and admission to neonatology are as expected&#44; considering the HT selection criteria&#46; There were no differences in sex&#44; single-parent habits and age at completion of the ASQ-3&#46; There were differences regarding university education and breastfeeding rate&#44; which were higher in the control group&#46; Maternal age in the LP group was 1 year older compared to the HT group&#44; and postnatal readmission during the first year of life was significantly higher among LPs&#46; The age at the time of the test was 47&#8211;50 months&#44; with an average of 48&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44; with no differences between groups&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">The average scores in each of the domains and the global performance of the ASQ-3 did not show differences between LP and HT &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0130" class="elsevierStylePara elsevierViewall">When plotting density of probabilities for the total score of ASQ-3&#44; it was noted that both groups have an equivalent distribution starting at a total score of 251 points&#44; and that below this point there are more LPs with low scores &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; This cut-off point was consistent with the 2 SD-average of the HT newborn sample of reference&#46; The ROC analysis showed a sensitivity of &#62;85&#46;5&#37; for this point&#46; The Kolmogorov&#8211;Smirnov test did not show evidence of a different distribution of probabilities between groups for scores over the cut-off point &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;68&#41;&#46; Based on this analysis&#44; a score equal to or lower than 250 was deemed a PDD risk&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">Analysing the groups based on the cut-off points&#44; 19 children appear to have PDD risk&#44; of which 15 were LPs &#40;16&#46;67&#37;&#41; and 4 were HTs &#40;4&#46;5&#37;&#41;&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">In the logistic regression model&#44; with explanatory biodemographic&#47;perinatal variables&#44; late prematurity &#40;OR 3&#46;68&#44; CI 95&#37;&#44; 1&#46;14&#8211;11&#46;81&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;03&#41; and the absence of breastfeeding &#40;OR 3&#46;3&#44; CI 95&#37;&#44; 1&#46;22&#8211;9&#46;3&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;02&#41; were significant&#46; In the model with explanatory clinical variables related to perinatal morbidity&#44; only prematurity was significant &#40;OR 5&#46;06&#44; CI 95&#37;&#44; 1&#46;6&#8211;15&#46;98&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;006&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Discussion</span><p id="par0145" class="elsevierStylePara elsevierViewall">A comparison of the global ASQ-3 score between LPs and HTs does not seem to support the initial working hypothesis&#46; The same may be said of each of the domains explored by the questionnaire&#44; in which no differences may be noted between groups&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">However&#44; considering the global score distribution in this sample&#44; differences do emerge&#44; so that LPs have higher PDD risk than HTs&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">These results encourage an in-depth analysis about long-term clinical significance&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">An objection might be based on the high percentage of non-participating LPs&#46; Difficulties contacting them hindered their involvement&#46; This was not the case with matched HTs since&#44; with a higher number of candidates&#44; those who were contacted and who met the inclusion criteria were enrolled&#46; It would be desirable to have a higher number of LPs&#44; but reaching the minimum number required by the sample calculation and the absence of differences in gestational age&#44; weight&#44; gender and neonatal morbidity between both groups suggest absence of bias in this respect&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Another aspect which should be considered is the characteristics of the population&#44; with a mid-high socio-economic level and a high university education of parents&#44; not comparable&#44; possibly&#44; with other studies focusing on a different social and economic population&#46; The influence of the socio-economic level is increasingly evident&#44; both in terms of neonatal morbidity as an independent factor<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">19</span></a> and in long term neurological development&#44; with PDD risk increasing when both levels are low&#46;<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">20&#44;21</span></a> The results obtained contrasted with ASQ-3 scores of children with PDD in Chile at 8&#44; 18 and 30 months&#46;<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">14&#44;22</span></a></p><p id="par0170" class="elsevierStylePara elsevierViewall">The completion of this study at 48 months is not random&#44; since it may be considered the last step for the detection of deficits that can benefit from therapy&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">23</span></a> The main difficulty in the application of this questionnaire resides in the absence of validation in our country&#46; It has been conducted in Spanish among younger children in Santiago de Chile<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">13&#44;14</span></a> and in Galicia&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">15</span></a> It is considered an excellent method for screening developmental difficulties in the USA&#44; the Netherlands&#44; Norway&#44; Canada&#44; France&#44; Korea&#44; Turkey&#44; India&#44; Iran and Brazil&#59; in these countries&#44; specific tests have been validated for each age&#44; with sensitivity and specificity of around 88&#37; and 82&#46;5&#37;&#44; respectively&#46;<a class="elsevierStyleCrossRefs" href="#bib0320"><span class="elsevierStyleSup">24&#44;25</span></a></p><p id="par0175" class="elsevierStylePara elsevierViewall">Considering deficits per domain decreases sensitivity and increases the specificity of the test&#44; and therefore some authors have chosen to use global scoring as an evaluation of psychomotor development&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">26</span></a></p><p id="par0180" class="elsevierStylePara elsevierViewall">Considering the characteristics of the study population&#44; with a highly selective control group as a reference&#44; the cut-off point is determined based on statistical criteria&#44; thus resulting in 251 points&#46; It was also observed that a greater number of children with PDD were found in the LP group compared to the HT control group &#40;16&#46;67&#37; vs&#46; 4&#46;5&#37;&#44; respectively&#41;&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">When the regression method was applied to demographic and perinatal variables&#44; only late prematurity and the absence of breastfeeding past 1 month of life were associated with PDD&#59; when it was applied to neonatal morbidity variables&#44; only gestational age was significant&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">For Schonhaut et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">22</span></a> in prematures with 32&#8211;36 weeks of gestational age&#44; gender&#44; restricted intrauterine growth &#40;RIG&#41;&#44; presence of twins&#44; and admission to neonatal intensive care &#40;ICU&#41; are factors probably associated with a higher risk of PDD&#44; while for Kerstjens et al&#46;&#44; these factors are multiple gestations&#44; RIG&#44; children of obese mothers&#44; and hypoglycaemia&#46;<a class="elsevierStyleCrossRefs" href="#bib0335"><span class="elsevierStyleSup">27&#44;28</span></a> None of these were listed as significant in our study population&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">Admission to the Neonatal Unit is associated with various hospital protocols&#46; It would probably be more accurate as a variable for admission into neonatal ICU&#44;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">29</span></a> although not everyone agrees that this is associated with poor neurological prognosis&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">30</span></a></p><p id="par0200" class="elsevierStylePara elsevierViewall">The significance of absence of breastfeeding in the study population is notable&#46; Breastfeeding is known to be a beneficial stimulant for brain development of LPs&#44; particularly during the myelination stage&#46;<a class="elsevierStyleCrossRefs" href="#bib0355"><span class="elsevierStyleSup">31&#44;32</span></a> Furthermore&#44; the difficulty of achieving successful breastfeeding among these children is well known&#44; due to neurological immaturity&#44; difficulties with suction and co-ordination&#44; difficulties with maternal lactogenesis&#44; and due to poor or no health training during the immediate neonatal period&#44; leading to hospital readmissions due to difficulties in feeding&#44; malnutrition&#44; hyperbilirubinaemia and hypoglycaemia&#46;<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">33</span></a></p><p id="par0205" class="elsevierStylePara elsevierViewall">Late prematurity and neonatal and postnatal morbidity appear to be significantly associated with PDD risk&#44;<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">19&#44;34&#44;35</span></a> this being greater the lower the gestational age&#46; However&#44; some studies have found no differences in neurological development of LPs at 12 months&#44;<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">36</span></a> and no conduct and learning issues during school age&#46;<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">37</span></a> Others&#44; on the contrary&#44; detect poorer school performance between 4 and 7 years among LPs&#46;<a class="elsevierStyleCrossRefs" href="#bib0390"><span class="elsevierStyleSup">38&#44;39</span></a></p><p id="par0210" class="elsevierStylePara elsevierViewall">If we accept the risk of this population presenting behavioural disorders&#44; we must be aware of the importance of having a useful&#44; easy and reliable tool for the early detection of PDD risk&#46; However&#44; the problem may reside in the adaptation and validation of this questionnaire to each population&#44; with the necessary adjustments in the cut-off points that define the standards&#46; The need to achieve maximum sensitivity is obvious&#44; but it is important to avoid an excessive number of false positives that would cause an emotional burden in families and a care burden for healthcare services&#46;<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">40</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conclusion</span><p id="par0215" class="elsevierStylePara elsevierViewall">The follow-up study shows&#44; in consideration of the global ASQ-3 score&#44; a higher prevalence of PDD risk among LPs compared to HT newborns according to the criteria used&#46; The consistency of these results should be checked to confirm their clinical significance&#46; The characteristics of the population&#44; as well as the absence of method validation in our country&#44; are limitations to consider&#46; In spite of wide consensus&#44; obtained through multiple published studies&#44; that LPs are at risk of presenting developmental anomalies&#44; even as adults&#44; it should be further investigated to determine if this statement corresponds to all the population or only to those with certain key perinatal development variables&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflict of interests</span><p id="par0220" class="elsevierStylePara elsevierViewall">The authors state there is no conflict of interest&#46;</p></span></span>"
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            1 => "Follow up"
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            0 => "Prematuro tard&#237;o"
            1 => "Seguimiento"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Lack of specific monitoring protocols hinders understanding of the impact of late prematurity on delayed psychomotor development&#46; The objective of this study is to evaluate this development at 48 months and compare it with infants born at term&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Population and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A retrospective cohort study was conducted on 90 late preterm &#40;LP&#41; and 89 term &#40;HT&#41; healthy children at 48 months&#44; assessed by the Ages &#38; Stages Questionnaires<span class="elsevierStyleSup">&#174;</span> &#40;ASQ-3&#41;&#46; Continuous variables were analysed using the Student&#39;s <span class="elsevierStyleItalic">t</span> test for independent samples and described in terms of mean and standard deviation&#46; The categorical variables were analysed using the <span class="elsevierStyleBold">chi-square test of independence</span> and described in terms of frequency and proportion&#46; ROC analysis was performed to determine the ASQ-3 cut-off value for risk of development deficit&#46; A step-wise logistic regression model identified the associated risk factors&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The mean scores for each domain and overall ASQ-3 score showed no differences between groups&#46; However&#44; when analyzing the probability density for the ASQ-3 total score of &#8804;251 points&#44; 15 LP &#40;16&#46;6&#37;&#41; and 4 AT &#40;4&#46;5&#37;&#41; showed risk of psychomotor deficits&#44; and late prematurity and lack of breastfeeding were significantly associated factors&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">There is an increased prevalence of risk of development deficit in LP infants&#44; which justifies considering this population at risk and establishing effective monitoring programmes&#46; It should be further investigated whether this risk corresponds to the entire population&#44; or if biological factors or perinatal history can increase vulnerability&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La ausencia de protocolos espec&#237;ficos de seguimiento dificulta el conocimiento de la repercusi&#243;n de la prematuridad tard&#237;a en el desarrollo psicomotor&#46; El objetivo es evaluarlo a los 4 a&#241;os y compararlo con los nacidos a t&#233;rmino &#40;AT&#41;&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Poblaci&#243;n y m&#233;todo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio de cohortes retrospectivo de 90 prematuros tard&#237;os &#40;PT&#41; y 89 AT sanos&#44; a los 48 meses&#44; evaluados mediante el Ages &#38; Stages Questionnaires<span class="elsevierStyleSup">&#174;</span> &#40;ASQ-3&#41;&#46; Las variables continuas se describen mediante media<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DE comparadas con el test de la t de Student para muestras independientes&#59; las variables categ&#243;ricas&#44; mediante frecuencias y proporciones&#44; comparadas con el test de independencia de la chi al cuadrado&#46; Se determin&#243; un punto de corte para la puntuaci&#243;n total del ASQ-3 capaz de discriminar el riesgo de d&#233;ficit del desarrollo mediante un an&#225;lisis ROC&#46; Una selecci&#243;n step-wise para el modelo de regresi&#243;n log&#237;stica determin&#243; los factores de riesgo asociados&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Las puntuaciones medias de cada dominio y de la puntuaci&#243;n global del ASQ-3 no mostraron diferencias entre ambos grupos&#46; Sin embargo&#44; al analizar la densidad de probabilidades para la puntuaci&#243;n global del ASQ-3<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>251 puntos&#44; 15 PT &#40;16&#44;6&#37;&#41; y 4 AT &#40;4&#44;5&#37;&#41; mostraban riesgo de d&#233;ficit psicomotor&#44; y la prematuridad tard&#237;a y la ausencia de lactancia materna resultaron factores asociados significativamente&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Hubo una mayor prevalencia de riesgo de d&#233;ficit en el desarrollo en los PT&#44; lo que justifica considerar esta poblaci&#243;n de riesgo y establecer programas de seguimiento eficientes&#46; Debe seguirse investigando si este riesgo corresponde a toda la poblaci&#243;n o si existen factores biol&#243;gicos o antecedentes perinatales que los hacen m&#225;s vulnerables&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Demestre X&#44; Schonhaut L&#44; Morillas J&#44; Mart&#237;nez-Nadal S&#44; Vila C&#44; Raspall F&#44; et al&#46; Riesgo de d&#233;ficits en el desarrollo en los prematuros tard&#237;os&#58; evaluaci&#243;n a los 48 meses mediante el Ages &#38; Stages Questionnaires<span class="elsevierStyleSup">&#174;</span>&#46; An Pediatr &#40;Barc&#41;&#46; 2016&#59;84&#58;39&#8211;45&#46;</p>"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Probability density total ASQ-3 scores according to gestational age&#46;</p>"
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          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">ASQ-3&#44; Ages &#38; Stages Questionnaires&#59; SD&#44; standard deviation&#59; NS&#44; non-significant&#59; LP&#44; late premature&#59; NU&#44; Neonatal Unit&#59; GA&#44; gestational age&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Non-included LP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Study LP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Healthy term&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">N</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">89&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Weight&#44; average<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD &#40;g&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2505<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>351&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2464<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>437&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3337&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>447&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">GA&#44; average<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD &#40;weeks&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">39&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Male &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">33 &#40;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">55 &#40;61&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">49 &#40;55&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Twin &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30 &#40;45&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">34 &#40;38&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Caesarean &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">44 &#40;66&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">57 &#40;63&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">39 &#40;43&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">NU admission &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">33 &#40;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">54 &#40;60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Maternal university education&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">69 &#40;76&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;0485&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">76 &#40;85&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Single parent &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;3&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;2&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Age of the mother&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">39&#46;24<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">38&#46;02<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Breastfeeding &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">54 &#40;60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">65 &#40;73&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">48&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">48&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Postnatal readmission &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12 &#40;13&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 &#40;5&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">ASQ-3 score &#40;average<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Late premature &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>90&#41; &#40;average<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">57&#46;92<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;97&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Gross motor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">55&#46;22<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">55&#46;84<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Fine motor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">52&#46;22<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">54&#46;21<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Problem resolution&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">56&#46;33<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">57&#46;08<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
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        "texto" => "<p id="par0225" class="elsevierStylePara elsevierViewall">To Mireia Corrales&#44; for her collaboration in the delivery&#44; counselling&#44; and collection of questionnaires at the homes of parents&#46; To Gabriel Cavada&#44; a Chilean biostatistician&#44; for his statistical counselling&#46; To the Private Foundation of Ms Naccari Rava &#40;&#8225;&#41;&#44; a regular selfless collaborator of the hospital&#46; To the paediatricians&#44; Pere Catal&#225;&#44; Xavier Costa&#44; Dolors Cuadra&#44; Esperan&#231;a Llorens&#44; Inmaculada Puig and Felipe Velasco&#44; for allowing the completion of questionnaires in their offices&#46;</p>"
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ISSN: 23412879
Original language: English
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