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

Executive Function and its Impact on Academic and Behavior Problems in Very Preterm Children

Preterm birth occurs before 37 weeks of gestation and includes late preterm birth (gestational age: 32-37 weeks), very preterm birth (gestational age < 32 weeks), and extremely preterm birth (gestational age < 27 weeks) according to the World Health Organization (2010). Risk factors associated with preterm birth include ethnicity, multiple pregnancies, pregnancy after in vitro fertilization, maternal or infant infections, and unfavorable social environmental circumstances. The obstetric precursors leading to preterm birth are delivery for maternal or fetal indications, in which labor is either induced or the infant is delivered by caesarean section, spontaneous preterm labor with intact membranes, and, preterm premature rupture of the membranes, irrespective of whether delivery is vaginal or by caesarean section. In the Netherlands, 7.7% of all births are preterm and 1.5% are very preterm.3 Because of technological advances and collaboration between obstetricians and neonatologists, survival rates for (very) preterm infants have dramatically increased. A 1-kg infant who was born in 1960 had a mortality risk of 95% but had a 95% probability of survival by 2000. Despite the improved perinatal care, developmental outcomes of these infants remain of concern since immature organs, such as brains and lungs, are extremely vulnerable for adverse consequences of very preterm birth. Adverse developmental outcomes include respiratory illnesses and abnormal growth patterns, but also severe neurosensory disabilities, such as cerebral palsy, mental retardation, and deafness or blindness. These problems are generally detected and treated early in infancy and the incidence is fortunately relatively low. There is growing awareness, however, that the majority of very preterm children that survive without such overt neurosensory disabilities and with normal intelligence suffers from long-term problems. These long-term problems become apparent at school age and comprise fine and gross motor dysfunction, neurocognitive dysfunction such as impaired visuo-spatial, or language skills, poor academic achievement, and behavior problems. In the Netherlands, 38% of these children have special assistance at school10 and about 20% attend special education compared to 4.8% of the normal population

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

Development of preschool and academic skills in children born very preterm

To examine performance in preschool and academic skills in very preterm (gestational age ≤ 30 weeks) and term-born comparison children aged 4 to 12 years. Very preterm children (n = 200; mean age, 8.2 ± 2.5 years) born between 1996 and 2004 were compared with 230 term-born children (mean age, 8.3 ± 2.3). The Dutch National Pupil Monitoring System was used to measure preschool numerical reasoning and early linguistics, and primary school simple and complex word reading, reading comprehension, spelling, and mathematics/arithmetic. With univariate analyses of variance, we assessed the effects of preterm birth on performance across grades and on grade retention. In preschool, very preterm children performed comparably with term-born children in early linguistics, but perform more poorly (0.7 standard deviation [SD]) in numerical reasoning skills. In primary school, very preterm children scored 0.3 SD lower in complex word reading and 0.6 SD lower in mathematics/arithmetic, but performed comparably with peers in reading comprehension and spelling. They had a higher grade repeat rate (25.5%), although grade repeat did not improve their academic skills. Very preterm children do well in early linguistics, reading comprehension, and spelling, but have clinically significant deficits in numerical reasoning skills and mathematics/arithmetic, which persist with tim

Neonatal and parental predictors of executive function in very preterm children

Aim To examine neonatal and parental predictors of executive function in very preterm (gestational age ≤30 weeks) children aged 4.0-12.0 years. Methods Two-hundred very preterm (mean age 8.2 ± 2.5 years) children without severe disabilities, born between 1996 and 2004, were assessed with measures of executive function including working memory, verbal fluency, planning and inhibitory control. Neonatal predictors were obtained from clinical records. Parental predictors included parental education, which was derived from questionnaires. Multiple linear regression analyses identified associations between neonatal and parental predictors and executive function in very preterm children. Results Better postnatal growth at 6 weeks of corrected age-predicted better spatial span (