IMPORTANCE Despite apparent progress in perinatal care, children born extremely or very preterm (EP/VP) remain at high risk for cognitive deficits. Insight into factors contributing to cognitive outcome is key to improve outcomes after EP/VP birth. OBJECTIVE To examine the cognitive abilities of children of EP/VP birth (EP/VP children) and the role of perinatal and demographic risk factors. DATA SOURCES PubMed, Web of Science, and PsycINFO were searched without language restriction (last search March 2, 2017). Key search terms included preterm, low birth weight, and intelligence. STUDY SELECTION Peer-reviewed studies reporting intelligence scores of EP/VP children (<32 weeks of gestation) and full-term controls at age 5 years or older, born in the antenatal corticosteroids and surfactant era, were included. A total of 268 studies met selection criteria, of which 71 covered unique cohorts. DATA EXTRACTION AND SYNTHESIS MOOSE guidelines were followed. Data were independently extracted by 2 researchers. Standardized mean differences in intelligence per study were pooled using random-effects meta-analysis. Heterogeneity in effect size across studies was studied using multivariate, random-effects meta-regression analysis. MAIN OUTCOMES AND MEASURES Primary outcome was intelligence. Covariates included gestational age, birth weight, birth year, age at assessment, sex, race/ethnicity, socioeconomic status, small for gestational age, intraventricular hemorrhage, periventricular leukomalacia, bronchopulmonary dysplasia (BPD), necrotizing enterocolitis, sepsis, and postnatal corticosteroid use. RESULTS The 71 included studies comprised 7752 EP/VP children and 5155 controls. Median gestational age was 28.5 weeks (interquartile range [IQR], 2.4 weeks) and the mean age at assessment ranged from 5.0 to 20.1 years. The median proportion of males was 50.0% (IQR, 8.7%). Preterm children had a 0.86-SD lower IQ compared with controls (95% CI, −0.94 to −0.78, P < .001). Results were heterogeneous across studies (I 2 = 74.13; P < .001). This heterogeneity could not be explained by birth year of the cohort. Multivariate meta-regression analysis with backward elimination revealed that BPD explained 65% of the variance in intelligence across studies, with each percent increase in BPD rate across studies associated with a 0.01-SD decrease in IQ (0.15 IQ points) (P < .001). CONCLUSIONS AND RELEVANCE Extremely or very preterm children born in the antenatal corticosteroids and surfactant era show large deficits in intelligence. No improvement in cognitive outcome was observed between 1990 and 2008. These findings emphasize that improving outcomes after EP/VP birth remains a major challenge. Bronchopulmonary dysplasia was found to be a crucial factor for cognitive outcome. Lowering the high incidence of BPD may be key to improving long-term outcomes after EP/VP birth.

, van der Boechorststraat 1, 1081 BT Amsterdam, the Netherlands (jf.de.kieviet@psy .vu.nl). Context Infants who are very preterm (born Յ32 weeks of gestation) and very low birth weight (VLBW) (weighing Յ1500 g) are at risk for poor developmental outcomes. There is increasing evidence that very preterm birth and VLBW have a considerable effect on motor development, although findings are inconsistent. Objective To investigate the relationship between very preterm birth and VLBW and motor development. Data Sources The computerized databases EMBASE, PubMed, and Web of Knowledge were used to search for English-language peer-reviewed articles published between January 1992 and August 2009. Study Selection Studies were included if they reported motor scores of very preterm and VLBW children without congenital anomalies using 1 of 3 established and widely used motor tests: the Bayley Scales of Infant Development II (BSID-II), the Movement Assessment Battery for Children (MABC), and the Bruininks-Oseretsky Test of Motor Proficiency (BOTMP). Forty-one articles were identified, encompassing 9653 children. Results In comparison with term-born peers, very preterm and VLBW children obtained significantly lower scores on all 3 motor tests: BSID-II: d=−0.88

VLBW very low birthweightAIM The aim of this article was to clarify the impact and consequences of very preterm birth (born <32wks of gestation) and ⁄ or very low birthweight ([VLBW], weighing <1500g) on brain volume development throughout childhood and adolescence.METHOD The computerized databases PubMed, Web of Knowledge, and EMBASE were searched for studies that reported volumetric outcomes during childhood or adolescence using magnetic resonance imaging and included a term-born comparison group. Fifteen studies were identified, encompassing 818 very preterm ⁄ VLBW children and 450 term-born peers. Average reductions in the total brain volume, white matter volume, grey matter volume, and in the size of the cerebellum, hippocampus, and corpus callosum were investigated using meta-analytic methods. INTERPRETATION Very preterm ⁄ VLBW birth is associated with an overall reduction in brain volume, which becomes evident in equally sized reductions in white and grey matter volumes, as well as in volumes of diverse brain structures throughout childhood and adolescence. RESULTSThe incidence of very preterm ⁄ very low-birthweight (VLBW) birth has increased over the past decades, although the chance of survival of very preterm ⁄ VLBW children has also considerably increased. However, there is strong evidence that very preterm ⁄ VLBW birth has negative consequences on motor, cognitive, and behavioural functioning.1-3 These negative developmental outcomes parallel various alterations in brain development. 4 Owing to disturbances in the normal maturational processes of the brain, in particular the myelination process, white matter injury is predominant in very preterm ⁄ VLBW children.5 Alterations in white matter development are intertwined with cortical grey matter alterations, as cortical organization and synaptic development are facilitated by axons providing a functional link between deep brain areas and the cortex. 5,6 Because alterations in white and grey matter have profound implications for motor, 7,8 cognitive, 9 and behavioural functioning, 10 a clear overview of affected brain areas will enable better predictions of developmental difficulties in very preterm ⁄ VLBW children. Nowadays, magnetic resonance imaging (MRI) is a well-established, non-invasive method for determining brain volume development in children. Although several studies have measured differences in brain development between very preterm ⁄ VLBW children and a term-born comparison group by examining brain structure volumes using MRI volumetry, outcomes differ owing to variations in study designs. In the existing literature, two types of studies have emerged: studies reporting on reductions in whole-brain volumes 9,11 and studies targeting reductions in volumes of a specific region of interest, such as the cerebellum or corpus callosum. 8,12 This meta-analysis aims to improve understanding of the exact impact of very preterm ⁄ VLBW birth on brain development throughout childhood and adolescence by aggregating the existing data across both types of ...

BackgroundAdvances 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.ObjectiveTo study academic performance in preterm children born in the antenatal steroids and surfactant era and possible moderating effects of perinatal and demographic factors.DesignPubMed, 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.ResultsThe 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). Bronchopulmonarydysplasia explained 44% of the variance in academic performance (p=0.006).ConclusionPreterm children born in the antenatal steroids and surfactant era show considerable academic difficulties. Preterm children with bronchopulmonarydysplasia are at particular risk for poor academic outcome.

(Abstracted from JAMA Pediatr 2018;172(4):361–367) Despite apparent progress in perinatal care, children born extremely preterm or very preterm (EP/VP) remain at high risk of cognitive deficits, and long-term morbidity rates have not decreased. Extremely preterm or very preterm birth (<32 weeks of gestation) is associated with higher risks of motor, learning, and behavior problems and, particularly, cognitive impairment.