Cognitive and neuropsychological outcomes at 5 years of age in preterm children born in the 2000s

Abstract

AIM The aim of this study was to assess the cognitive level and neuropsychological performance at 5 years of age in children with a very low birthweight (VLBW; birthweight <1501g) born in 2001 to 2003.METHOD A regional cohort of 97 children with a VLBW (mean gestational age 28wks [SD 3wks]; mean birthweight 1054g [SD 259g]; 50 male; 47 female) and a comparison group of 161 healthy children born at term (mean gestational age 40wks [SD 1wks]; mean birthweight 3644g [SD 446g]; 80 male; 81 female) were included in this study. At 5 years of age (SD 2mo) cognitive level was assessed with the Wechsler Preschool and Primary Scale of Intelligence -revised and neuropsychological performance was assessed using NEPSY II. RESULTSThe mean intelligence of the VLBW group corresponded to the normative mean of 100 but was lower than the mean of the low-risk comparison group (p<0.001). Neuropsychological performance was also significantly poorer than that of the comparison group. In NEPSY II, 25% of the VLBW group had a significantly impaired performance in one of 11 subtests and 33% had a significantly impaired performance in more than one, while 19% of the comparison group had a significantly impaired performance in one subtest and 10% had a significantly impaired performance in more than one.INTERPRETATION The mean cognitive capacity of the VLBW cohort corresponded to the normative mean. However, assessments of cognitive level only at preschool age do not provide the information on neuropsychological deficit that is necessary for planning adequate educational support.Preterm birth predisposes the infant to long-term developmental problems. As diverging developmental outcomes in different regions, 1 centres, 2 hospital levels, 3 and time periods 4,5 have been reported, continuous regional follow-up is needed for the evaluation of treatment and for the planning of adequate developmental support. There are some encouraging reports on the decreasing rate of cerebral palsy (CP) among preterm children, 4,6 as well as on the improved cognitive outcome of preterm children at 2 years of age, 7 but similar trends regarding the neurocognitive outcome at preschool age have not yet been reported. Thus, there is a need to learn more about the long-term cognitive and neuropsychological development of children with a very low birthweight (VLBW) born during the present decade.It has been shown that children who were born preterm achieve lower scores on intelligence tests 8,9 than their peers born at term. They also have more impairments in various domains of neuropsychological functioning than children born at term. [8][9][10][11][12] Some studies suggest that preterm birth is associated with general intellectual impairment rather than with specific dysfunctions, 13 whereas others report specific impairments despite cognitive levels within a normal range. 10 The aim of the present study was to assess cognitive and neuropsychological outcomes at 5 years of age in a regional cohort of children with a VLBW born in 2001 to 2003 and to analyse the e...

Longitudinal Studies of Executive and Cognitive Development After Preterm Birth

“…The gain of smooth pursuit in infant eye movement was significantly lower at 2 and 4 months in children born preterm in comparison to term born children (Strand-Brodd et al, 2011). Visuospatial and visuo-motor deficits from infancy and through later childhood have also been frequently reported (Cioni et al, 1997;Groen, de Blecourt, Postema, & Hadders-Algra, 2005;Ornstein, Ohlsson, Edmonds, & Asztalos, 1991;Saigal & O'Brodovich, 1987) and a higher gestational age has been associated with better visuo-motor skills in VLBW children (Lind et al, 2011). Deficits in visual-motor integration often remain at school age, and preterm children with such deficits and poor motor competence are at risk of developing writing and mathematics-related learning disabilities (Chaudhari, Otiv, Chitale, Pandit, & Hoge, 2004).…”

“…Preterm children's developmental outcome and predictors thereof have been the focus of a large number of studies. According to some reports preterm birth is associated with general intellectual impairment rather than with specific dysfunctions (Hoff Esbjørn, Hansen, Greisen, & Mortensen, 2006), whereas other studies report on specific impairments despite normal overall cognitive levels (Bayless & Stevenson, 2007;Böhm, Smedler, & Forssberg, 2004;Lind et al, 2011). …”

Estudio comparativo de funciones neuropsicológicas a los 8 años de niños prematuros y nacidos de término

“…Los resultados coinciden parcialmente con estudios revisados respecto de las funciones neuropsicoló-gicas 5,8 . La atención se perfila como un área con alto deterioro.…”

“…Estos niños presentarían un rendimiento más pobre que sus pares a término en evaluaciones de memoria 7 ; atención visual, habilidad visomotora, copia de diseños, procesamiento fonológi-co 8 ; procesamiento visoespacial, lenguaje 9 . En evaluación de FE niños PE exhiben un rendimiento menor que los controles en flexibilidad cognoscitiva pero no en memoria de trabajo ni capacidad de inhibición 10 .…”

“…En algunos estudios se ha encontrado que los niños prematuros obtienen resultados similares que los niños a término en memoria de trabajo, pero utilizando diferentes áreas cerebrales; prematuros de menor edad, y con menor rendimiento, evidencian formas de trabajo atípicas, mientras que prematuros de mayor edad, y con mejor rendimiento, presentan esquemas de trabajo similar a sus pares de término 11 . En los últimos años se observaría una mejoría en el desempeño de PE en pruebas neuropsicológicas y cognitivas 8 , sin que los nacidos con menor edad gestacional obtengan necesariamente puntajes más bajos. Existiría una amplia variabilidad en el rendimiento de estos niños dependiendo de la interacción entre grado de prematuridad, complicaciones médicas y factores ambientales o sociales 12 .…”