Meta-Analysis of Neurobehavioral Outcomes in Very Preterm and/or Very Low Birth Weight Children

Abstract

Birth Weight Children Meta-Analysis of Neurobehavioral Outcomes in Very Preterm and/or Very Lowhttp://www.pediatrics.org/cgi/content/full/124/2/717 located on the World Wide Web at:The online version of this article, along with updated information and services, is Meta-Analysis of Neurobehavioral Outcomes in Very Preterm and/or Very Low Birth Weight Children abstract OBJECTIVE: Sequelae of academic underachievement, behavioral problems, and poor executive function (EF) have been extensively reported for very preterm (Յ33 weeks' gestation) and/or very low birth weight (VLBW) (Յ1500 g) children. Great variability in the published results, however, hinders the field in studying underlying dysfunctions and developing intervention strategies. We conducted a quantitative meta-analysis of studies published between 1998 and 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 (Ͻ0.28) and for externalizing behavior problems negligible (Ͻ0.09) and not significant. Combined effect sizes for EF revealed a decrement of 0.57 SD for verbal fluency, 0.36 SD for working memory, and 0.49 SD for cognitive flexibility in comparison to controls. Mean age at assessment was not correlated with the strength of the effect sizes. Mathematics and reading performance, parent ratings of internalizing problems, teacher ratings of externalizing behavior, and attention problems, showed strong and positive correlations with mean birth weight and mean gestational age (all r values Ͼ 0.51). CONCLUSIONS:Very preterm and/or VLBW children have moderate-toseveredeficitsinacademicachievement,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.

Reading deficits in very low birthweight children are associated with vocabulary and attention issues at the age of seven

“…Similar results for attention problems were found in the meta‐analysis by Aarnoudse‐Moens et al. 2. Attention difficulties that had an impact on academic achievement were detected in children born very preterm, even in the absence of a diagnosis and without signs of hyperactivity/impulsivity 24, indicating a core deficit in attention in children born preterm 25.…”

“…Cognitive deficits, behavioural problems and learning difficulties occur more frequently among school‐age children with a very low birthweight (VLBW) of <1500 g, and in particular in children with an extremely low birthweight (ELBW) of <1000 g, than children born at term 1, 2, 3, 4, 5. The effects of poor academic achievement in primary school persist through adolescence and into young adulthood for VLBW and ELBW infants 6, 7.…”

Comportamento de Escolares Estratificados pelo Peso ao Nascer e Idade Gestacional

“…Pelos dois critérios de estratificação da coorte, os dados obtidos são concordantes com os dados da literatura que apontam para a vulnerabilidade desses grupos (Aarnoudse-Moens et al, 2009;Bhutta et al, 2002;Dahl et al, 2006;Martins et al, 2005;Msall & Park, 2008;Oliveira et al, 2011). Constatou-se ainda, que as crianças nascidas com baixo peso apresentaram mais dificuldades na escala de sintomas emocionais em comparação aos nascidos com peso normal, mas não apresentaram mais problemas comportamentais avaliados pelo escore total, enquanto as crianças nascidas PIG apresentaram mais sintomas emocionais e também mais dificuldades quanto ao escore total em comparação às nascidas AIG.…”

“…Alguns estudos mostram que crianças nascidas com baixo peso apresentam mais problemas comportamentais em comparação às crianças nascidas com peso normal (Aarnoudse-Moens, Weisglas-Kuperus, Goudoever, & van Osterlaan, 2009;Bhutta, Cleves, Casey, Cradock, & Anand, 2002;Conrad, Richman, Lindgren, & Nopoulos, 2009;Gallo et al, 2011;Hack et al, 2004;Martins, Linhares, & Martinez, 2005;Oliveira, Enumo, Queiroz, & Azevedo Jr, 2011;Reijneveld et al, 2006;Rodrigues, Mello, & Fonseca, 2006;Wiles et al, 2006). Em estudo conduzido por Gallo et al (2011), por exemplo, foi avaliada uma coorte de 4.357 crianças, aos 11 anos, por meio do Questionário de Capacidades e Dificuldades (do inglês Strengths and Difficulties Questionnaire -SDQ), com o objetivo de verificar a associação entre o tamanho ao nascimento e SKB Correia et al problemas de saúde mental.…”

Preterm Toddlers' Inhibitory Control Abilities Predict Attention Regulation and Academic Achievement at Age 8 Years

“…Preterm birth increases the risk for attention difficulties [1][2][3][4] as well as long-term academic underachievement [3,5,6]. Studies have suggested that early self-control abilities (e.g.…”