Executive Functioning in School-Aged Children Who Were Born Very Preterm or With Extremely Low Birth Weight in the 1990s
* Royal Women’s Hospital, Melbourne, Australia
Murdoch Children’s Research Institute, Melbourne, Australia
University of Melbourne, Melbourne, Australia
Objective. To determine the frequency, nature, and severity of executive dysfunction (EDF) at 8 years of age in extremely low birth weight (ELBW)/very preterm infants who were born in the 1990s, compared with normal birth weight (NBW) control subjects.
Methods. A geographically determined cohort study was conducted in Victoria, Australia. The ELBW/very preterm cohort comprised 298 consecutive survivors at 2 years of age who had gestational ages <28 completed weeks or birth weights <1000 g and were born during 1991-1992. The NBW cohort comprised 262 randomly selected children of birth weight >2499 g matched on date of birth, gender, ethnicity, and health insurance status. The participation rate was 92% (275 of 298) for the ELBW/very preterm cohort and 85% (223 of 262) for the NBW cohort. Cognitive and behavioral measures of executive functioning were administered.
Results. The ELBW/very preterm cohort exhibited significant EDF compared with their NBW peers in all areas assessed. The cognitive assessment revealed global impairment rather than deficits in specific executive domains. The ELBW/very preterm children also displayed more behavioral problems indicative of EDF than the NBW children. Severe impairments were exhibited in only a small minority of ELBW/very preterm children. No statistical conclusions were altered after adjustment for sociodemographic variables or when children with substantial neurosensory impairment were excluded.
Conclusions. School-aged children who were born in the 1990s and were very preterm or had ELBW are at greater risk for developing EDF and require ongoing neuropsychological review throughout middle childhood.
Key Words: executive function • executive dysfunction • extremely low birth weight • very preterm • prematurity
Abbreviations: NBW, normal birth weight • EF, executive function • EDF, executive dysfunction • ELBW, extremely low birth weight • PVL, periventricular leukomalacia • IVH, intraventricular hemorrhage • CI, confidence interval • BRIEF, Behavior Rating Inventory of Executive Function
Received for publication May 5, 2003; Accepted Nov 16, 2003.
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