Meta-Analysis of Neurobehavioral Outcomes in Very Preterm and/or Very Low Birth Weight Children

OBJECTIVE: Sequelae of academic underachievement, behavioral problems, and poor executive function (EF) have been extensively reported for very preterm (≤33 weeks' gestation) and/or very low birth weight (VLBW) (≤1500 g) children. Great variability in the published results, however, hinders the field in studying underlying dysfunctionsanddeveloping intervention strategies. We conductedaquantitative meta-analysis of studies publishedbetween1998and 2008 on academic achievement, behavioral functioning, and EF with the aim of providing aggregated measures of effect size for these outcome domains. METHODS: Suitable for inclusion were 14 studies on academic achievement, 9 studies on behavioral problems, and 12 studies on EF, which compared a total of 4125 very preterm and/or VLBW children with 3197 term-born controls. Combined effect sizes for the 3 outcome domains were calculated in terms of Cohen's d. Q-test statistics were performed to test homogeneity among the obtained effect sizes. Pearson's correlation coefficients were calculated to examine the impact of mean birth weight and mean gestational age, as well as the influence of mean age at assessment on the effect sizes for academic achievement, behavioral problems, and EF. RESULTS: Combined effect sizes show that very preterm and/or VLBW children score 0.60 SD lower on mathematics tests, 0.48 SD on reading tests, and 0.76 SD on spelling tests than term-born peers. Of all behavioral problems stacked, attention problems were most pronounced in very preterm and/or VLBW children, with teacher and parent ratings being 0.43 to 0.59 SD higher than for controls, respectively. Combined effect sizes for parent and teacher ratings of internalizing behavior problems were small ( 0.51). CONCLUSIONS: Very preterm and/or VLBW children have moderate-toseveredeficits inacademicachievement,attentionproblems, andinternalizing behavioral problems and poor EF, which are adverse outcomes that were strongly correlated to their immaturity at birth. During transition to young adulthood these children continue to lag behind term-born peers

Mathematics difficulties in children born very preterm: current research and future directions

This article was published in the journal, Archives of Disease in Childhood: Fetal and Neonatal Edition [BMJ Publishing Group / © the authors]. The definitive version is available at: http://dx.doi.org/10.1136/archdischild-2013-303777Children born very preterm have poorer attainment in all school subjects, and a markedly greater reliance on special educational support than their term-born peers. In particular, difficulties with mathematics are especially common and account for the vast majority of learning difficulties in this population. In this paper, we review research relating to the causes of mathematics learning difficulties in typically developing children, and the impact of very preterm birth on attainment in mathematics. Research is needed to understand the specific nature and origins of mathematics difficulties in very preterm children to target the development of effective intervention strategies

DHA supplementation during the perinatal period and neurodevelopment: do some babies benefit more than others?

A dietary supply of docosahexaenoic acid (DHA, 22:6n-3) during the perinatal period is postulated to be important for the neurodevelopmental outcome of children. This paper reviews the results of two large scale intervention trials in which equivalent dietary doses of DHA were assessed. One trial assessed the ex utero effect of DHA supplementation for preterm infants born <33 weeks' gestation while the other trial assessed the in utero effect of DHA supplementation during the second half of pregnancy. Ex utero DHA supplementation, which aimed to achieve the level of DHA accumulation that would occur in the womb, appeared more effective in improving the neurodevelopmental outcome of preterm children rather than in utero DHA supplementation of unborn infants. Significant treatment by sex and treatment by birth weight interactions were noted indicating that boys and girls respond differently to DHA supplementation and that birth weight may also be important in predicating the DHA responsiveness.Maria Makride

Alterações no neuro desenvolvimento em pré-escolares com antecedente de prematuridade: um estudo de corte

Antecedentes: Existe evidencia de la relación de la prematurez con alteraciones en el neurodesarrollo y desenlaces negativos en la salud mental. En Colombia no se han realizado estudios a la fecha sobre el tema.&nbsp; Método: Se realizó un estudio transversal que analizó una muestra aleatoria de 97 historias clínicas de preescolares (p=0.005) del Hospital Militar Central en Bogotá, Colombia, excluyendo lesiones neurológicas no relacionadas con el periodo neonatal como secuelas de trauma cráneo encefálico, malformaciones cerebrales, síndromes genéticos identificados y maltrato infantil. Se aplicó Escala Abreviada del Desarrollo (EAD-1) y la “Child Behavior Checklist” (CBCL) y se tomaron datos sociodemográficos. Resultados: Se presentaron correlaciones positivas y estadísticamente significativas, entre la edad gestacional y todos los percentiles de las subescalas de neurodesarrollo: motor grueso (p=,035), fino/adaptativo (p=,009), audición/lenguaje (p=,005) y personal/social (p=,019); y entre el peso al nacer y todos los percentiles de las subescalas de neurodesarrollo: motor grueso (p=,043), fino/adaptativo (p=,005), audición/lenguaje (p=,006) y personal/social (p=,001), siendo esta última la mayor correlación de todas. Conclusiones: Este estudio muestra que los niños con antecedente de prematurez presentan un riesgo aumentado de problemas en el desarrollo, sobretodo quienes presentaron peso al nacer inferior a 1500 grs o menos de 32 semanas de edad gestacional, correlacionando las alteraciones en el neurodesarrollo con las alteraciones comportamentales en el grupo de niños estudiado. Hay pocos reportes del cuidado de la salud y la rehabilitación durante la infancia para los niños nacidos pretérmino; en el Hospital Militar Central por ser un hospital que cuenta con un programa de seguimiento de alto riesgo neurológico, se evidencia que la intervención y atención oportuna disminuye el porcentaje de alteración en el neurodesarrollo y el comportamiento

Cognitive outcomes in children and adolescents born very preterm:A meta-analysis

Aim To estimate the association between very preterm birth (<32wks' gestation) and intelligence, executive functioning, and processing speed throughout childhood and adolescence, and to examine the effects of gestational age, birthweight, and age at assessment. Method Studies were included if children were born at earlier than 32 weeks’ gestation, aged 4 to 17 years, had an age-matched term control group, and if the studies used standardized measures, were published in an English-language peer-reviewed journal, and placed no restrictions on participants based on task performance. Results We evaluated 6163 children born very preterm and 5471 term-born controls from 60 studies. Children born very preterm scored 0.82 SDs (95% confidence interval [CI] 0.74–0.90; p<0.001) lower on intelligence tests, 0.51 SDs (95% CI 0.44–0.58; p<0.001) lower on measures of executive functioning, and 0.49 SDs (95% CI 0.39–0.60; p<0.001) lower on measures of processing speed than term-born controls. Gestational age and birthweight were associated with study effect size in intelligence and executive functioning of younger children only. Age at assessment was not associated with study effect size. Interpretation Children born very preterm have medium to large deficits in these cognitive domains. What this paper adds This meta-analysis is centred on very preterm birth and three cognitive domains. The three critical cognitive domains are intelligence, executive functioning, and processing speed

Academic performance of children born preterm : a meta-analysis and meta-regression

Background: Advances in neonatal healthcare have resulted in decreased mortality after preterm birth but have not led to parallel decreases in morbidity. Academic performance provides insight in the outcomes and specific difficulties and needs of preterm children. Objective: To study academic performance in preterm children born in the antenatal steroids and surfactant era and possible moderating effects of perinatal and demographic factors. Design: PubMed, Web of Science and PsycINFO were searched for peer-reviewed articles. Cohort studies with a full-term control group reporting standardised academic performance scores of preterm children (<37 weeks of gestation) at age 5 years or older and born in the antenatal steroids and surfactant era were included. Academic test scores and special educational needs of preterm and full-term children were analysed using random effects meta-analysis. Random effects meta-regressions were performed to explore the predictive role of perinatal and demographic factors for between-study variance in effect sizes. Results: The 17 eligible studies included 2390 preterm children and 1549 controls. Preterm children scored 0.71 SD below full-term peers on arithmetic (p<0.001), 0.44 and 0.52 SD lower on reading and spelling (p<0.001) and were 2.85 times more likely to receive special educational assistance (95% CI 2.12 to 3.84, p<0.001). Bronchopulmonary dysplasia explained 44% of the variance in academic performance (p=0.006). Conclusion: Preterm children born in the antenatal steroids and surfactant era show considerable academic difficulties. Preterm children with bronchopulmonary dysplasia are at particular risk for poor academic outcome

Executive function and IQ predict mathematical and attention problems in very preterm children

Objective of this study was to examine the impact of executive function (EF) on mathematical and attention problems in very preterm (gestational age ≤ 30 weeks) children. Participants were 200 very preterm (mean age 8.2 ± 2.5 years) and 230 term children (mean age 8.3 ± 2.3 years) without severe disabilities, born between 1996 and 2004. EFs assessed included verbal fluency, verbal working memory, visuospatial span, planning, and impulse control. Mathematics was assessed with the Dutch Pupil Monitoring System and parents and teachers rated attention problems using standardized behavior questionnaires. The impact of EF was calculated over and above processi

The Role of Maternal Smoking in Effect of Fetal Growth Restriction on Poor Scholastic Achievement in Elementary School

Fetal growth restriction and maternal smoking during pregnancy are independently implicated in lowering intellectual attainment in children. We hypothesized that only reduction of fetal growth that is attributable to extrinsic causes (e.g., maternal smoking) affects intellectual development of a child. Cross-sectional survey of 3,739 students in Nova Scotia (Canada) in 2003 was linked with the perinatal database, parental interviews on socio-demographic factors and the performance on standardized tests when primarily 11–12 years of age, thereby forming a retrospective cohort. Data was analyzed using hierarchical logistic regression with correction for clustering of children within schools. The risk of poor test result among children born small-for-gestational-age (SGA) to mothers who smoked was 29.4%, higher than in any other strata of maternal smoking and fetal growth. The adjusted odds ratio among SGA children born to mothers who smoked was the only one elevated compared to children who were not growth restricted and born to mothers who did not smoke (17.0%, OR = 1.46, 95% CI 1.02, 2.09). Other perinatal, maternal and socio-demographic factors did not alter this pattern of effect modification. Heterogeneity of etiology of fetal growth restriction should be consider in studies that address examine its impact on health over life course

Women's views and experiences of two alternative consent pathways for participation in a preterm intrapartum trial: a qualitative study

BACKGROUND: The Cord Pilot Trial compared alternative policies for timing of cord clamping at very preterm birth at eight UK hospitals. In addition to standard written consent, an oral assent pathway was developed for use when birth was imminent. The aim of this study was to explore women's views and experiences of two alternative consent pathways to participate in the Cord Pilot Trial. METHODS: We conducted a qualitative study using semi-structured interviews. A total of 179 participants in the Cord Pilot Trial were sent a postal invitation to take part in interviews. Women who agreed were interviewed in person or by telephone to explore their experiences of two consent pathways for a preterm intrapartum trial. Data were analysed using inductive systematic thematic analysis. RESULTS: Twenty-three women who gave either written consent (n = 18) or oral assent followed by written consent (n = 5) to participate in the trial were interviewed. Five themes were identified: (1) understanding of the implications of randomisation, (2) importance of staff offering participation, (3) information about the trial and time to consider participation, (4) trial secondary in women's minds and (5) reasons for agreeing to take part in the trial. Experiences were similar for the two consent pathways. Women recruited by the oral assent pathway reported being given less information about the trial but felt it was sufficient to make a decision regarding participation. There were gaps in women's understanding of the trial and intervention, regardless of the consent pathway. CONCLUSIONS: Overall, women were positive about their experiences of being invited to participate in the trial. The oral assent pathway seems an acceptable option for women if the intervention is low-risk and time is limited. TRIAL REGISTRATION: ISRCTN Registry, ISRCTN21456601 . Registered on 28 February 2013