Abstract
This study aimed to investigate cognitive and behavioral outcomes in relation to gestational age (GA) in school-aged children born preterm (PT). Results from the Wechsler Intelligence Scale for Children, 4th edition (WISC-IV), and the Child Behavior Checklist (CBCL) were analyzed in 51 children (mean age: 7.8 years [range: 7.0–8.7]) born PT (mean GA: 31 weeks [range: 23–35]; birth weight, mean: 1,637 g [range: 404–2,962]) with the majority (96%) having no diagnosed cognitive, sensory, or motor impairments. The control group included 57 age-matched typically developing children (mean age: 7.9 years [range: 6.2–8.7]) born full-term (FT). Children born PT, extremely PT (GA < 28) in particular, showed significantly lower cognitive performance and higher behavioral problem scores compared with children born FT. GA was found to predict aspects of both cognitive functioning and behavioral problems within the PT group, with lower GA being related to both poorer cognitive outcomes and elevated affective and attention-deficit/hyperactivity problems. Global cognitive functioning did not independently predict aspects of behavioral outcomes. Findings demonstrate that, even in children born PT without severe perinatal and/or postnatal complications and receiving active perinatal care, a short gestation is an evident risk factor for long-term negative effects on mental health independent of cognitive functioning. Additional findings suggest that both reduced growth and lower parental educational level may contribute to increased risk for poorer cognitive and behavioral functioning in children born PT.
Highlights
A large body of evidence on long-term impaired functionality in children born preterm (PT, < 37 weeks’ gestation, GW) consistently suggest cognitive and behavioral difficulties as two major problem areas [1,2,3,4,5,6,7,8]
It was found that attention-deficit hyperactivity disorder (ADHD) was diagnosed twice as often in children born PT compared with those born full-term (FT) and that neurodevelopmental deficits in children born PT persist beyond primary school age [12]
Note that excluding the two participating children with hemiplegic cerebral palsy (HCP) did not significantly change the results presented
Summary
A large body of evidence on long-term impaired functionality in children born preterm (PT, < 37 weeks’ gestation, GW) consistently suggest cognitive and behavioral difficulties as two major problem areas [1,2,3,4,5,6,7,8]. Emerging neurodevelopmental problems in children born PT with no diagnosed impairment are difficult to predict with accuracy and may not be recognized until middle childhood [13] At this age, children born PT may display both poorer cognitive and educational achievements [1, 2, 14], more externalizing behavioral disturbances such as impulsivity and hyperactivity, and internalizing behaviors such as anxiety, depression, and social problems [1,2,3, 8, 15] than peers born term. There is no general agreement between studies whether behavioral problems in school-aged children born PT are of mainly externalizing or internalizing nature This discrepancy is likely related to known differences in both cognitive and behavioral presentations depending on whether children have been born at an extremely, very, or moderately/late gestational age [10]. Additional study to corroborate such proposed relations is required
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