Cognitive Outcomes for Extremely Preterm/Extremely Low Birth Weight Children in Kindergarten

Department of Psychology, Case Western Reserve University, Cleveland, Ohio, USA.
Journal of the International Neuropsychological Society (Impact Factor: 2.96). 09/2011; 17(6):1067-79. DOI: 10.1017/S135561771100107X
Source: PubMed


Our objectives were to examine cognitive outcomes for extremely preterm/extremely low birth weight (EPT/ELBW, gestational age <28 weeks and/or birth weight <1000 g) children in kindergarten and the associations of these outcomes with neonatal factors, early childhood neurodevelopmental impairment, and socioeconomic status (SES). The sample comprised a hospital-based 2001-2003 birth cohort of 148 EPT/ELBW children (mean birth weight 818 g; mean gestational age 26 weeks) and a comparison group of 111 term-born normal birth weight (NBW) classmate controls. Controlling for background factors, the EPT/ELBW group had pervasive deficits relative to the NBW group on a comprehensive test battery, with rates of cognitive deficits that were 3 to 6 times higher in the EPT/ELBW group. Deficits on a measure of response inhibition were found in 48% versus 10%, odds ratio (95% confidence interval) = 7.32 (3.32, 16.16), p < .001. Deficits on measures of executive function and motor and perceptual-motor abilities were found even when controlling for acquired verbal knowledge. Neonatal risk factors, early neurodevelopmental impairment, and lower SES were associated with higher rates of deficits within the EPT/ELBW group. The findings document both global and selective cognitive deficits in EPT/ELBW children at school entry and justify efforts at early identification and intervention.

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    • "gnitive delay heightened for children born VLBW (OR = 5.27, P univ = 0.01) [90]. The six studies that examined very or extremely LBW as the EOI also found that these BWs were associated with lower cognitive scores (i.e., 7.6–16.2 points) as compared to those born full term among cohorts of children ranging in age from 1.5 to eight years old (P<0.05 [91]; P univ (s)< 0.059293949596). Effects of LBW status were also detrimental in three studies independent of EOIs (i.e., dietary Hg [71, 75] or economic indicators and parenting quality [23]). LBW as a result of intrauterine growth restriction during multiple gestation was also a negative predictor of cognitive score at two years old in an"
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    ABSTRACT: The etiology of a child's cognitive ability is complex, with research suggesting that it is not attributed to a single determinant or even a defined period of exposure. Rather, cognitive development is the product of cumulative interactions with the environment, both negative and positive, over the life course. The aim of this systematic scoping review was to collate evidence associated with children's cognitive health, including inherent factors as well as chemical and non-chemical stressors from the built, natural, and social environments. Three databases were used to identify recent epidemiological studies (2003-2013) that examined exposure factors associated with general cognitive ability in children. Over 100 factors were evaluated from 258 eligible studies. We found that recent literature mainly assessed the hypothesized negative effects of either inherent factors or chemical exposures present in the physical environment. Prenatal growth, sleep health, lead and water pollutants showed consistent negative effects. Of the few studies that examined social stressors, results consistently showed cognitive development to be influenced by both positive and negative social interactions at home, in school or the community. Among behavioral factors related to diet and lifestyle choices of the mother, breastfeeding was the most studied, showing consistent positive associations with cognitive ability. There were mostly inconsistent results for both chemical and non-chemical stressors. The majority of studies utilized traditional exposure assessments, evaluating chemical and non-chemical stressors separately. Collective evidence from a limited number of studies revealed that cumulative exposure assessment that incorporates multiple chemical and non-chemical stressors over the life course may unravel the variability in effect on cognitive development and help explain the inconsistencies across studies. Future research examining the interactions of multiple stressors within a child's total environment, depicting a more real-world exposure, will aid in understanding the cumulative effects associated with a child's ability to learn.
    Preview · Article · Feb 2016 · PLoS ONE
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    • "Together, these deficits contribute to the prematurity-related burden of chronic disease in adulthood [2,3]. Infants born extremely preterm (<28 weeks gestational age) are particularly prone to chronic neurological deficits, with up to one half experiencing significant cognitive delay and behavioral problems [4,5]. To identify and refine targets for new therapeutic interventions, a clearer understanding of how perinatal insults translate to impaired neurodevelopment is imperative. "
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    ABSTRACT: Background Infants born preterm commonly suffer from a combination of hypoxia-ischemia (HI) and infectious perinatal inflammatory insults that lead to cerebral palsy, cognitive delay, behavioral issues and epilepsy. Using a novel rat model of combined late gestation HI and lipopolysaccharide (LPS)-induced inflammation, we tested our hypothesis that inflammation from HI and LPS differentially affects gliosis, white matter development and motor impairment during the first postnatal month. Methods Pregnant rats underwent laparotomy on embryonic day 18 and transient systemic HI (TSHI) and/or intra-amniotic LPS injection. Shams received laparotomy and anesthesia only. Pups were born at term. Immunohistochemistry with stereological estimates was performed to assess regional glial loads, and western blots were performed for protein expression. Erythropoietin ligand and receptor levels were quantified using quantitative PCR. Digigait analysis detected gait deficits. Statistical analysis was performed with one-way analysis of variance and post-hoc Bonferonni correction. Results Microglial and astroglial immunolabeling are elevated in TSHI + LPS fimbria at postnatal day 2 compared to sham (both P < 0.03). At postnatal day 15, myelin basic protein expression is reduced by 31% in TSHI + LPS pups compared to shams (P < 0.05). By postnatal day 28, white matter injury shifts from the acute injury pattern to a chronic injury pattern in TSHI pups only. Both myelin basic protein expression (P < 0.01) and the phosphoneurofilament/neurofilament ratio, a marker of axonal dysfunction, are reduced in postnatal day 28 TSHI pups (P < 0.001). Erythropoietin ligand to receptor ratios differ between brains exposed to TSHI and LPS. Gait analyses reveal that all groups (TSHI, LPS and TSHI + LPS) are ataxic with deficits in stride, paw placement, gait consistency and coordination (all P < 0.001). Conclusions Prenatal TSHI and TSHI + LPS lead to different patterns of injury with respect to myelination, axon integrity and gait deficits. Dual injury leads to acute alterations in glial response and cellular inflammation, while TSHI alone causes more prominent chronic white matter and axonal injury. Both injuries cause significant gait deficits. Further study will contribute to stratification of injury mechanisms in preterm infants, and guide the use of promising therapeutic interventions.
    Full-text · Article · Aug 2014 · Journal of Neuroinflammation
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    • "Children born preterm (b 38 weeks gestation), born with low birth weight (b2500 g), or born smaller in size than normal for gestational age (weight below 10th percentile for the gestational age) have increased risks for ongoing health and developmental problems . Across a wide range of degrees of prematurity, survivors have high rates of neurodevelopmental and behavioral disorders that impact on their physical and social–emotional health, learning and community participation [1] [2] [3] [4] [5] [6] [7] [8] [9] [10] [11]. From the developmental and life course perspective, cognitive and behavioral outcomes measured at school entry, often conceptualized as school readiness skills, are particularly important for success in learning in groups and maintaining positive relationships with peers [12] [13]. "
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    ABSTRACT: This study aims to examine the relationship between indicators of prematurity and children's cognitive and behavioral school readiness in a nationally representative sample and to investigate whether typically occurring preschool enrollment moderates this relationship, particularly for children from disadvantaged families in Australia. The Longitudinal Study of Australian Children is a nationally representative prospective sample of two cohorts of children with sequentially obtained indicators of child health and developmental outcomes. We analyzed information on 8060 children aged 4-5years who had complete data on birth weight, gestational age, prenatal risks, social factors, and cognitive and behavioral outcomes of school readiness. Multivariate regressions were used to relate three indicators of prematurity (low birth weight, preterm birth, and small for gestational age) to cognitive and behavioral school readiness. Children born preterm, small for gestational age, or with low birth weight have significantly lower cognitive school readiness after controlling for social factors and prenatal risks. None of the premature indicators were associated with behavioral school readiness. All children benefited from attending preschool. Yet, preschool enrollment did not moderate the relationship between prematurity and school readiness. The only exception is for small for gestational age survivors with low educated mothers. Preschool enrollment was associated with an increase in cognitive school readiness skills. Prematurity was associated with lower cognitive school readiness skills. Typical occurring preschool did not eliminate this association. Findings suggest that simply expanding the preschool enrollment is inadequate to address the developmental needs of premature children from disadvantaged backgrounds.
    Full-text · Article · Jan 2014 · Early human development
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