Abstract
<h3>Importance</h3> Preterm birth is associated with an increased risk for long-lasting attention deficits. Early-life markers of attention abnormalities have not been established to date but could provide insights into the pathogenesis of attention abnormalities and could help identify susceptible individuals. <h3>Objective</h3> To examine whether preterm birth is associated with visual attention impairments in early life, and if so, in which attention functions and at which developmental period during the first 2 years of life. <h3>Data Sources</h3> PubMed and PsycINFO were searched on November 17, 2019, to identify studies involving visual attention outcomes in infants born preterm vs full term. <h3>Study Selection</h3> Peer-reviewed studies from the past 50 years met the eligibility criteria if they directly assessed visual attention outcomes until the age of 2 years in generally healthy infants born preterm or full term. The selection process was conducted by 2 independent reviewers. <h3>Data Extraction and Synthesis</h3> The Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guideline was followed. Random-effects models were used to determine standardized mean differences. The risk of bias was assessed both within and between studies. <h3>Main Outcomes and Measures</h3> Five nascent indices of visual attention were analyzed, including very basic functions—namely, the abilities to follow and fixate on visual targets—and more complex functions, such as visual processing (ie, habituation), recognition memory (ie, novelty preference), and the ability to effortfully focus attention for learning. <h3>Results</h3> A total of 53 studies were included, with 69 effect sizes and assessing a total of 3998 infants (2047 born preterm and 1951 born full term; of the 3376 for whom sex was reported, 1693 [50.1%] were girls). Preterm birth was associated with impairments in various attention indices, including visual-following in infancy (Cohen<i>d</i>, −0.77; 95% CI, −1.23 to −0.31), latency to fixate (Cohen<i>d</i>, −0.18; 95% CI, −0.33 to −0.02), novelty preference (Cohen<i>d</i>, −0.20; 95% CI, −0.32 to −0.08), and focused attention (Cohen<i>d</i>, −0.28; 95% CI, −0.45 to −0.11). In the neonatal period, preterm birth was associated with superior visual<i>-</i>following (Cohen<i>d</i>, 0.22; 95% CI, 0.03 to 0.40), possibly owing to the additional extrauterine exposure to sensory stimulation. However, this early association waned rapidly in infancy (Cohen<i>d</i>, –0.77; 95% CI, –1.23 to –0.31). <h3>Conclusions and Relevance</h3> The findings suggest that preterm birth is associated with impingements to visual attention development in early life, as manifested in basic and then complex forms of attention. Advancements in neonatal care may underlie improvements found in the current era and accentuate several early protective factors.
Highlights
Preterm birth, a live birth before gestational age (GA) of 37 weeks,[1] is associated with substantial developmental challenges
Preterm birth was associated with impairments in various attention indices, including visual-following in infancy (Cohen d, −0.77; 95% CI, −1.23 to −0.31), latency to fixate (Cohen d, −0.18; 95% CI, −0.33 to −0.02), novelty preference (Cohen d, −0.20; 95% CI, −0.32 to −0.08), and focused attention (Cohen d, −0.28; 95% CI, −0.45 to −0.11)
Preterm birth was associated with superior visual-following (Cohen d, 0.22; 95% CI, 0.03 to 0.40), possibly owing to the additional extrauterine exposure to sensory stimulation
Summary
A live birth before gestational age (GA) of 37 weeks,[1] is associated with substantial developmental challenges. Advancements in obstetrics and neonatal care have been associated with an increase in preterm births worldwide,[2] which account for 10.6% of live births.[3] Despite the positive aspects of better survival and care, preterm birth has implications for learning,[4] cognitive performance,[4,5,6] and attention[5]; deficits in these areas may underlie the association of preterm birth with poorer quality of life[7] and substantial economic costs.[8,9]. Neurodevelopmental frameworks advocate a model that traces the long-term cognitive sequelae of preterm birth to the cascading implications of early dysfunctions in regulatory and attentional facets.[14,15,16] This approach accentuates the idea that the emerging operations of higher cortical loci, which are later to materialize from both the phylogenetic and the ontogenetic perspectives, are influenced by earlier dysregulation of midbrain structures,[17,18] compromising the distributed attentional networks further as the child matures.[19,20,21] The stagespecific behavioral-attention expressions of this cascade are not yet fully mapped
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
