Extremely premature children demonstrate stable executive function throughout childhood

1. Executive function (EF) performance remained stable from 8 to 18 years old among the majority of children born extremely premature (EP) or with extremely low birth weight (ELBW).

2. EP and ELBW children with typical EF development outperformed children with persistent, intermittent, or late-onset deficits in all academic domains.

Evidence Rating Level: 2 (Good)

Study Rundown: Studies show that being EP (<28 weeks gestation) or having ELBW (<1000g) are risk factors for developing cognitive and behavioral deficits, but little is known about these trajectory of impairments change throughout childhood. Authors of this study aimed to characterize behavioral EF, defined as cognitive control processes (working memory, inhibition, planning, etc), as well as academic performance, in EP and ELBW children at 8 and 18 years old. Children were grouped into 4 categories based on the questionnaire results: typical development, remitting deficits, persistent deficits, and late-onset deficits. Results showed that the majority of children had a stable EF (were classified in the same subgroup) between 8 and 18 years. Most children had normal EF development, the fewest participants had remitting deficits, and <20% had late-onset deficits. Children with typical development did better academically than children in the other subgroups. One limitation of this study was its low statistical power, which prevented the investigation of the influence of socioeconomic factors on cognitive development. Results from this study suggest the need to better understanding the variables that lead to remitting or improved neurocognitive development in order to improve interventions available for EP and ELBW children.

Click to read the study, published today in Pediatrics

Relevant reading: Cognitive, behavior, and social competence of preterm low birth weight children at school age

In-depth [prospective cohort]: Study participants included 180 EP and ELBW children born between 1991-1992 who survived to 18 years old from Victoria, Australia. EF and academic performance were evaluated at ages 8 and 18 using parental reports of the Behavior Rating Inventory of Executive Function (BRIEF, broken down into 2 broad indices, the Behavioral Regulation Index [BRI] and Metacognition Index [MCI]) and the Wide Range Achievement Test (WRAT4) respectively. Results showed that EF of the majority of children did not change between 8 and 18 years (BRI remained stable in 76% of participants and the MCI was stable in 68%). Of those who remained stable, the frequency of each subgroup based on the BRI and MCI categories respectively were as follows: typical (61%, 53%); persistent deficits (15%, 16%); remitting deficits (12%, 13%); and late-onset impairments (12%, 19%). Children who had typical EF performed better than persistent or late-onset subgroups on all academic outcomes, whereas the persistent deficit subgroup performed the worst in all academic categories for the BRI and had the lowest spelling scores for the MCI. In both the BRI and MCI, children in the typical group were more likely to be female and from families with a higher social class.

Image: PD

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