Learning disabilities among extremely preterm children without neurosensory impairment: Comorbidity, neuropsychological profiles and scholastic outcomes

Johnson, Samantha; Strauss, Victoria Y; Gilmore, Camilla; Jaekel, Julia; Marlow, Neil; Wolke, Dieter

doi:10.1016/j.earlhumdev.2016.07.009

Cited by 55 publications

(58 citation statements)

References 48 publications

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“…In a population-based Swedish study of infants born <27 weeks’ gestation at 6 years, nearly 30% had moderate or severe cognitive delay compared with 2.5% of term children (3). A 10-fold greater risk for intellectual or learning disability was seen at 11-years of age among children born <26 weeks’ gestation compared with term in the EPICure cohort (4). With increasing survival of infants born EPT (5), an enhanced understanding of neonatal predictors of childhood outcomes is important to accurate counseling and to inform future interventions to ameliorate later impairments.…”

Section: Introductionmentioning

confidence: 99%

Preterm Neuroimaging and School-Age Cognitive Outcomes

et al. 2018

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Background and Objectives: Children born extremely preterm (EPT) are at risk for cognitive difficulties and disability. The relative prognostic value of neonatal brain MRI and cranial US (CUS) for school-age outcomes remains unclear. Our objectives were to relate near-term conventional brain MRI and early and late CUS to cognitive impairment and disability at 6–7 years among children born EPT, and assess their prognostic value. Methods: A prospective study of adverse early and late CUS and near-term conventional MRI findings to predict outcomes at 6–7 years including FSIQ <70 and moderate-severe disability (FSIQ<70, moderate-severe cerebral palsy, or severely vision or hearing impaired) in a subgroup of SUPPORT enrollees. Stepwise logistic regression evaluated associations of neuroimaging with outcomes, adjusting for perinatal-neonatal factors. Results: 386 children had follow up at 6–7 years. In unadjusted analyses, severity of white matter abnormality and cerebellar lesions on MRI, and adverse CUS findings were associated with 6–7 year outcomes. In full regression models, both adverse late CUS findings (OR 27.9, 95%CI 6.0–129) and significant cerebellar lesions on MRI (OR 2.71, 95% CI 1.1–6.7) remained associated with moderate-severe disability, but only adverse late CUS findings (OR 20.1, 95%CI 3.6–110.8) with FSIQ<70. Predictive accuracy of stepwise models was not substantially improved with addition of neuroimaging. Conclusions: Severe but rare adverse late CUS findings were most strongly associated with cognitive impairment and disability at school-age, and significant cerebellar lesions on MRI were associated with disability. Near-term conventional MRI did not substantively enhance prediction of FSIQ<70 or moderate-severe disability at early school age.

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Section: Introductionmentioning

confidence: 99%

Preterm Neuroimaging and School-Age Cognitive Outcomes

et al. 2018

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“…quarter of a standard deviation lower on arithmetic and about half a standard deviation lower on reading and spelling than their full-term born peers (Twilhaar, de Kieviet, Aarnoudse-Moens, van Elburg, & Oosterlaan, 2018). The prevalence of learning disability, either with or without comorbid intellectual disability, is significantly higher among children born extremely preterm (38%) compared to full-term born children (3%) (Johnson et al, 2016). Moreover, preterm born children are more likely to receive special educational assistance (Twilhaar et al, 2018).…”

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confidence: 99%

Neurocognitive processes underlying academic difficulties in very preterm born adolescents

Twilhaar

Kieviet

Elburg

et al. 2019

Child Neuropsychology

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Very preterm birth is associated with academic difficulties, but the underlying neurocognitive mechanisms of these difficulties remain largely unclear. The present study aimed to assess the role of working memory (WM), attentional processes, and processing speed in academic difficulties of very preterm born adolescents at 13 years. Participants included 55 very preterm and 61 full-term adolescents. Academic performance, visuospatial WM, alerting, orienting, executive attention, sustained attention, and processing speed (simple and choice reaction time [RT]) were compared between groups. Mediation analyses with multiple, parallel mediators were performed to examine whether these functions mediate the relation between very preterm birth and academic performance. Very preterm born adolescents showed poorer reading comprehension, arithmetic, visuospatial WM, alerting, sustained attention, and choice RT than full-term controls. The relationship between very preterm birth and arithmetic was mediated by visuospatial WM, sustained attention, and choice RT. The relationship between very preterm birth and reading comprehension was mediated by visuospatial WM and choice RT. The findings indicate that very preterm birth affects arithmetic and reading comprehension through its negative effect on visuospatial WM, sustained attention, and processing speed. These neurocognitive processes may identify very preterm born children at risk for academic difficulties and could serve as targets for interventions.

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“…Da fikk 81% undervisning i spesialskole eller ekstra ressurser i vanlig skole på grunn av lav IQ eller spesifikke laerevansker. I kontrollgruppen fikk 11% ekstra ressurser 17 .…”

Section: Komplikasjoner I Nyfødtperiodenunclassified

Det ekstremt for tidlig fødte barnet; hvordan går det?

Markestad¹

2017

Nor J Epidemiol

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This is an open access article distributed under the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Sønn av president John F. Kennedy og kona Jacqueline, Patrick, ble født 5 ½ uke for tidlig i 1963 og veide 2110 gram. Han døde etter 2 døgn av neonatalt ånde-nødssyndrom (respiratory distress syndom -RDS) som skyldes mangel på surfaktant. Det var det vanlige utfallet av betydelig prematuritet den gangen. Patricks død ga støtet til økt forskning i nyfødtmedisin. I 1964 viste Paul R. Swyer i Toronto at for tidlig fødte barn med umodne lunger kunne overleve med respiratorbehandling 1 , og respiratorbehandling ble snart rutine. De neste store fremskrittene var å gi glukokortikoid til mor før fødsel for å fremme fosterets surfaktantsyntese 2 (rutine fra ca. 1980) og å sprøyte farmasøytisk fremstilt surfaktant ned i lungene (fra begynnelsen av 1990-tallet) 3 . Sammen med bedre teknologi for assistert ventilasjon og overvåkning av vitale funksjoner, samt økt kunnskap og kompetanse, har dette ført til at få av barna dør av lungesykdom i dag.Selv om risikoen for død og alvorlige funksjonsnedsettelser øker med grad av prematuritet 4 , er det i dag størst bekymring knyttet til fremtidig helse og funksjonsnivå hos barn som overlever ekstrem prematuritet, dvs. fødsel før 28 ukers svangerskap. Det gjelder ca. 0,5% av alle fødsler i Norge, ca. 300 barn per år 5 . I dag er det mulig å redde noen barn som fødes i uke 22, men hva som bør vaere en nedre grense for å tilby livreddende behandling, diskuteres kontinuerlig. I Sverige er det blitt vanlig å behandle fra 22 svangerskapsuker 6,7 mens Frankrike i praksis ikke gir livreddende behandling ved 23 uker og i langt mindre grad enn hos oss ved 24 uker 8 . I Norge diskuteres det om det er etisk akseptabelt å avstå fra å gi livreddende behandling ved fødsel før 24 svangerskapsuker, og om hvilke skader og sykdom som kan vaere grunnlag for å avslutte livsforlengende behandling 9 . En fersk spørre-undersøkelse viser at alle føde-og barneavdelingene i Norge i praksis gir livreddende behandling ved fødsel i uke 24 uten vanligvis å gå inn på en diskusjon om dette med foreldrene, og også i uke 23 dersom foreldrene ønsker eller aksepterer det 10 . Noen få barn har de siste årene også overlevd etter fødsel i uke 22.Nyfødtmedisinen må nok alltid leve i en gråsone for når det er rimelig å tilby livreddende behandling og for hva foreldrene skal kunne kreve, både med hensyn til å avstå fra og forlange aktiv behandling. Forskningsbasert kunnskap om prognose med tanke på overlevelse og risiko for funksjonsnedsettelser, belastning for barnet og familien og kostnad for samfunnet, er grunnleggende for en fruktbar diskusjon om grenser for å starte livreddende behandling, sammen med vekting av etiske prinsipper om retten til liv.

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Learning disabilities among extremely preterm children without neurosensory impairment: Comorbidity, neuropsychological profiles and scholastic outcomes

Cited by 55 publications

References 48 publications

Preterm Neuroimaging and School-Age Cognitive Outcomes

Preterm Neuroimaging and School-Age Cognitive Outcomes

Neurocognitive processes underlying academic difficulties in very preterm born adolescents

Det ekstremt for tidlig fødte barnet; hvordan går det?

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