Risk factors for cognitive impairment in school-age children born preterm: application of a hierarchical model

Abstract

The purpose was to analyze factors associated with cognitive impairment in very low birth weight (VLBW) children born preterm. A prospective cohort of 65 VLBW children was assessed at the age of eight years using the Wechsler Intelligence Scale for Children. A model for the relationship of variables with the cognitive impairment outcome attributed hierarchical levels: distal (socioeconomic variables), intermediate I and II (perinatal and neonatal variables, post-neonatal variables) and proximal (child health and psychosocial stimulation). A multivariate logistic regression was performed. In the multivariate hierarchical logistic regression, the maternal education (OR=0.77, 95%CI 0.63-0.94) and number of prenatal visits (OR=0.73, 95%CI 0.54-0.99) showed a protective association, but the male (OR=7.3, 95%CI 1.54-35.3) was associated with worse results. The VLBW children cognitive performance in the age of eight years benefits from more educated mothers, better prenatal care, and the baby gender as female.

Maternal Education Level Predicts Cognitive, Language, and Motor Outcome in Preterm Infants in the Second Year of Life

“…18,19 Our findings are consistent with prior studies demonstrating a protective effect of high MEL on cognitive and language function in preterm infants. [1][2][3][4][5] However, our findings are among the first to reveal an association between MEL and motor outcome in this population. Several studies conducted with preterm infants born in the 1980s and 1990s established significant relationships between MEL and ND outcome in childhood and young adulthood.…”

“…2,4 Similarly, whereas recent studies of preterm infants have also found a positive impact of MEL on cognitive outcome, we could locate only one previous study that compared ND outcome for MEL subgroups in a preterm infant cohort born after 2000 and utilized the BSITD-III to measure language in addition to cognitive outcomes. 1,3,5 Ko et al reported that infants born to mothers with MEL of ! partial college had significantly higher cognitive scores at 18 to 24 months as compared with mothers of MEL <HS, and those born to mothers with MEL of !…”

“…Maternal education level (MEL) is known to have a significant impact on neurodevelopmental (ND) outcome in preterm infants, and some studies suggest that it may be a more powerful predictor of ND outcome than gestational age (GA) at birth and neonatal morbidities incurred during the neonatal intensive care unit (NICU) hospitalization, including sepsis, intraventricular hemorrhage (IVH), and bronchopulmonary dysplasia (BPD). [1][2][3][4][5] Although recently published studies have demonstrated a beneficial impact of higher MEL on school-age outcomes, these studies have included preterm infants who were born prior to changes in perinatal management over the past decade and have focused exclusively on cognitive outcomes. [2][3][4][5] Advances in neonatal and obstetric care such as antenatal steroids, surfactant, and nutritional management have resulted not only in the improved survival of extremely preterm infants but also in a decrease in the incidence of morbidities known to impact neurodevelopment.…”

“…[1][2][3][4][5] Although recently published studies have demonstrated a beneficial impact of higher MEL on school-age outcomes, these studies have included preterm infants who were born prior to changes in perinatal management over the past decade and have focused exclusively on cognitive outcomes. [2][3][4][5] Advances in neonatal and obstetric care such as antenatal steroids, surfactant, and nutritional management have resulted not only in the improved survival of extremely preterm infants but also in a decrease in the incidence of morbidities known to impact neurodevelopment. [6][7][8] Furthermore, there is mounting evidence that greater provision of human milk (HM; milk from the infant's own mother, excluding donor human milk) in the NICU, most often seen in mothers with higher MEL, substantially improves childhood ND outcome in preterm infants and that lack of HM is an independent risk factor for cognitive impairment.…”

Early intervention leads to long‐term developmental improvements in very preterm infants, especially infants with bronchopulmonary dysplasia

“…Indeed, infants with BPD benefitted from the intervention, both in terms of cognitive and motor development. BPD affects as many as 35% of very preterm and VLBW infants (25) and is associated with white matter abnormalities in the brain, which have a negative influence on self-regulation and neurodevelopment in these infants (26). In addition, infants with BPD have difficulties in gaining homoeostatic, postural and state control due to breathing problems.…”