Association of high screen-time use with school-age cognitive, executive function, and behavior outcomes in extremely preterm children

1. In a cohort of extremely premature infants, high screen time contributes to adverse cognitive, executive function, and behavioural outcomes at ages 6 to 7.

Evidence Rating Level: 2 (Good)

Increased screen time is known to be negatively associated with cognitive development and executive function. Similarly, children who are born extremely premature, less than 28 weeks’ gestation, have been shown to be at increased risk of behavioural problems and executive function deficits. However, there is limited research on association of screen time with adverse outcomes in the high-risk preterm population. This cohort study sought to address this gap in literature, and included 414 participants (ages 6 to 7; 55% male), from which 238 had high screen time (>2 hours screen time) and 176 had low screen time (<2 hours screen time). The primary outcome measured was association of screen time with cognition, language, executive function, and behaviour at an early school age for children who were born extremely premature. It demonstrated that children with high screen time had decreased full scale intelligence quotient scores after adjustment of various confounding variables (mean [SE] difference, −3.92 [1.64]; P = 0.02). They also have significantly higher mean scores on the Behavior Rating Inventory of Executive Function metacognition index (mean [SE] difference, 2.82 [1.34]; P = 0.04) and on the global executive composite percentiles (mean [SE] difference, 7.49 [2.99]; P = 0.01).The secondary outcomes assessed were the association between high screen time and rates of structured physical activity, rates of overweight (defined as body mass index ≥85th percentile), and rates of obesity (defined as body mass index ≥95th percentile). Children high screen time were more likely to have lower mean [SD] minutes per day of structured physical activity than children with low screen time (8.07 [12] vs 4.42 [9]; P < .001). They also had higher rates of overweight (62 [28%] children; P < .001) and obesity (33 [15%] children; P < .001). Therefore, this is one of the first studies to demonstrate adverse associations of high screen time in children who were extremely premature, highlighting importance of educating patients and parents on these risks.

Click to read the study in JAMA Pediatrics

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