School-age Outcomes of Extremely Preterm or Extremely Low Birth Weight Children

OBJECTIVE: Research is required to monitor changes in the nature of neurobehavioral deficits in extremely preterm (EP) or extremely low birth weight (ELBW) survivors. This study examines cognitive, academic, and behavioral outcomes at age 8 years for a regional cohort of EP/ELBW children born in 1997. METHODS: The EP/ELBW cohort comprised all live births with a gestational age <28 weeks (EP) or birth weight <1000 g (ELBW) born in the state of Victoria, Australia, in 1997. Of 317 live births, 201 (63.4%) survived to 2 years of age. A term/normal birth weight (T/NBW) cohort was recruited comprising 199 infants with birth weights <2500 g or gestational age <37 weeks. Measures of intellectual ability, educational achievement, and behavior were administered at age 8. RESULTS: Retention was 94% for the EP/ELBW group and 87% for the T/NBW group. The EP/ELBW group performed poorer than the T/NBW group on measures of IQ, educational achievement, and certain behavioral domains, even after adjustment for sociodemographic factors and exclusion of children with neurosensory impairment. The rate of any neurobehavioral impairment was elevated in the EP/ELBW group (71% vs 42%), and one-half of subjects had multiple impairments. The outcomes for those with <750 g birth weight or <26 weeks' gestational age were similar to those with a birth weight of 750 to 999 g or a gestational age of 26 to 27 weeks, respectively. CONCLUSIONS: Despite ongoing improvements in the management of EP/ELBW infants, the rate of neurobehavioral impairment at school-age remains too high relative to controls.

[1]  J. Perrin,et al.  Racial and Ethnic Differences in Subspecialty Service Use by Children With Autism , 2013, Pediatrics.

[2]  S. Daniels,et al.  Triglyceride to HDL-C Ratio and Increased Arterial Stiffness in Children, Adolescents, and Young Adults , 2013, Pediatrics.

[3]  D. Vojta,et al.  Feasibility and Preliminary Outcomes of a Scalable, Community-based Treatment of Childhood Obesity , 2012, Pediatrics.

[4]  L. Doyle,et al.  Language abilities in children who were very preterm and/or very low birth weight: a meta-analysis. , 2011, The Journal of pediatrics.

[5]  Neil Marlow,et al.  Preterm Birth and Childhood Psychiatric Disorders , 2011, Pediatric Research.

[6]  Gehan Roberts,et al.  High Rates of School Readiness Difficulties at 5 Years of Age in Very Preterm Infants Compared with Term Controls , 2011, Journal of developmental and behavioral pediatrics : JDBP.

[7]  Gehan Roberts,et al.  Attention Problems in a Representative Sample of Extremely Preterm/Extremely Low Birth Weight Children , 2011, Developmental neuropsychology.

[8]  Roslyn N. Boyd,et al.  Preventive Care at Home for Very Preterm Infants Improves Infant and Caregiver Outcomes at 2 Years , 2010, Pediatrics.

[9]  N. Marlow,et al.  Processing speed and working memory underlie academic attainment in very preterm children , 2010, Archives of Disease in Childhood: Fetal and Neonatal Edition.

[10]  Gehan Roberts,et al.  Underestimation of developmental delay by the new Bayley-III Scale. , 2010, Archives of pediatrics & adolescent medicine.

[11]  P. Anderson,et al.  Prevalence of motor‐skill impairment in preterm children who do not develop cerebral palsy: a systematic review , 2010, Developmental medicine and child neurology.

[12]  Johan G. Eriksson,et al.  Slower Reaction Times and Impaired Learning in Young Adults With Birth Weight <1500 g , 2010, Pediatrics.

[13]  L. Doyle,et al.  Do early intervention programmes improve cognitive and motor outcomes for preterm infants after discharge? A systematic review , 2009, Developmental medicine and child neurology.

[14]  J. Oosterlaan,et al.  Meta-Analysis of Neurobehavioral Outcomes in Very Preterm and/or Very Low Birth Weight Children , 2009, Pediatrics.

[15]  N Marlow,et al.  Academic attainment and special educational needs in extremely preterm children at 11 years of age: the EPICure study , 2009, Archives of Disease in Childhood Fetal and Neonatal Edition.

[16]  L. Doyle,et al.  Neurodevelopmental outcomes of preterm infants fed high-dose docosahexaenoic acid: a randomized controlled trial. , 2009, JAMA.

[17]  L. Doyle,et al.  Long-term effects of caffeine therapy for apnea of prematurity. , 2007, The New England journal of medicine.

[18]  Samantha Johnson,et al.  Cognitive and behavioural outcomes following very preterm birth. , 2007, Seminars in fetal & neonatal medicine.

[19]  M. Schluchter,et al.  Consequences and Risks of <1000-g Birth Weight for Neuropsychological Skills, Achievement, and Adaptive Functioning , 2006, Journal of developmental and behavioral pediatrics : JDBP.

[20]  H. Forssberg,et al.  Computerized training of working memory in children with ADHD--a randomized, controlled trial. , 2005, Journal of the American Academy of Child and Adolescent Psychiatry.

[21]  A. LaCroix,et al.  Risk Factors Associated with Acute Pyelonephritis in Healthy Women , 2005, Annals of Internal Medicine.

[22]  L. Doyle,et al.  Neonatal intensive care at borderline viability--is it worth it? , 2004, Early human development.

[23]  L. Doyle,et al.  Executive functioning in school-aged children who were born very preterm or with extremely low birth weight in the 1990s. , 2004, Pediatrics.

[24]  L. Doyle.  Evaluation of neonatal intensive care for extremely low birth weight infants in Victoria over two decades: II. Efficiency. , 2004, Pediatrics.

[25]  L. Doyle,et al.  Effect of magnesium sulfate given for neuroprotection before preterm birth: a randomized controlled trial. , 2003, JAMA.

[26]  L. Doyle,et al.  Neurobehavioral outcomes of school-age children born extremely low birth weight or very preterm in the 1990s. , 2003, JAMA.

[27]  A. Bhutta,et al.  Cognitive and behavioral outcomes of school-aged children who were born preterm: a meta-analysis. , 2002, JAMA.

[28]  N. Minich,et al.  Verbal Memory Deficits in Children with Less than 750 g Birth Weight , 2000, Child neuropsychology : a journal on normal and abnormal development in childhood and adolescence.

[29]  R. Goodman,et al.  The extended version of the Strengths and Difficulties Questionnaire as a guide to child psychiatric caseness and consequent burden. , 1999, Journal of child psychology and psychiatry, and allied disciplines.

[30]  R. Goodman.  The Strengths and Difficulties Questionnaire: a research note. , 1997, Journal of child psychology and psychiatry, and allied disciplines.

[31]  K. Riegel,et al.  The cognitive outcome of very preterm infants may be poorer than often reported: An empirical investigation of how methodological issues make a big difference , 1994, European Journal of Pediatrics.

[32]  H. Taylor,et al.  Mathematics deficiencies in children with very low birth weight or very preterm birth. , 2009, Developmental disabilities research reviews.

[33]  Richard J Martin.  Long-Term Effects of Caffeine Therapy for Apnea of Prematurity , 2008 .

[34]  B. Tabachnick,et al.  Using multivariate statistics, 5th ed. , 2007 .

[35]  L. Doyle.  Evaluation of neonatal intensive care for extremely low birth weight infants in Victoria over two decades: I. Effectiveness. , 2004, Pediatrics.

[36]  J. Flynn.  Searching for Justice The Discovery of IQ Gains Over Time , 1999 .