Abstract
Prematurity presents a risk for higher order cognitive functions. Some of these deficits manifest later in development, when these functions are expected to mature. However, the causes and consequences of prematurity are still unclear. We conducted a longitudinal study to first identify clinical predictors of ultrasound brain abnormalities in 196 children born very preterm (VP; gestational age ≤32 weeks) and with very low birth weight (VLBW; birth weight ≤1500 g). At ages 8–16, the subset of VP-VLBW children without neurological findings (124) were invited for a neuropsychological assessment and an MRI scan (41 accepted). Of these, 29 met a rigorous criterion for MRI quality and an age, and gender-matched control group (n = 14) was included in this study. The key findings in the VP-VLBW neonates were: (a) 37% of the VP-VLBW neonates had ultrasound brain abnormalities; (b) gestational age and birth weight collectively with hospital course (i.e., days in hospital, neonatal intensive care, mechanical ventilation and with oxygen therapy, surgeries, and retinopathy of prematurity) predicted ultrasound brain abnormalities. At ages 8–16, VP-VLBW children showed: a) lower intelligent quotient (IQ) and executive function; b) decreased gray and white matter (WM) integrity; (c) IQ correlated negatively with cortical thickness in higher order processing cortical areas. In conclusion, our data indicate that facets of executive function and IQ are the most affected in VP-VLBW children likely due to altered higher order cortical areas and underlying WM.
Highlights
Despite increased survival and decreased morbidity of children born very premature (VP) with very low birth weight (VLBW), the long-term outcome of these children is variable
The very preterm-very low birth weight (VP-VLBW) had intact selective attention, impulsivity, vigilance, and resistance to (STROOP) interference, as well as spatial, everyday memory, and the different forms of recognition, learning and delayed memory assessed by the general memory and learning test test of memory and learning (TOMAL)
This cohort study had a percentage of preterm babies (8%) like that reported by other countries, with circa 1% born with same gestation and birth weight
Summary
Despite increased survival and decreased morbidity of children born very premature (VP) with very low birth weight (VLBW), the long-term outcome of these children is variable. Recognition of the risks and consequences is a concern through the world (World Health Organization, 2018) This concern is extensive from children born VP-VLBW who develop with brain and neurological deficits to those, the great majority nowadays, that instead grow with higher order cognitive difficulties. Common reported concerns are poorer intelligence quotient (IQ), working memory, attention, and executive function (Nosarti et al, 2008; Geldof et al, 2013; Kalpakidou et al, 2014; Eryigit Madzwamuse et al, 2015; Murray et al, 2016; Franz et al, 2018; Loe et al, 2018; Aanes et al, 2019) Such deficits, even if subtle, may hinder academic achievement as well as integration in society. What specific aspects of these functions are associated with changes in specific brain areas or networks
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